February 12, 2019

Tobacco cessation guideline:  Added clarification in the PAR and guideline text that Zyban brand must be dispensed to have the assessment fee covered by the DPEBB.

January 31, 2019

Tobacco cessation guideline:  Added section on chewing tobacco and vaporized nicotine under "Other Considerations."

December 6, 2018

Tobacco cessation guideline is now posted.  Pharmacists may now begin prescribing and billing for varenicline and Bupropion SR.

November 7, 2018

Emergency contraception guideline: important prescribing fee billing update, effective November 1st:
  • A minor ailment prescribing fee can ONLY be billed if ulipristal acetate is prescribed
  • No prescribing fee for levonorgestrel will be provided (the old system of levonorgestrel billing is also phased out) 

October 31, 2018

  • All guidelines have had their PARs updated to reflect new requirements put forth by SCPP council.  The change has added two new check boxes next to the "Counseling" heading; these are to remind the pharmacist to communicate to the patient that they may have the prescription filled at any pharmacy, and that their primary care provider will given details about the encounter
  • The following guidelines have had billing details added to reflect the expanded coverage of the prescribing fee for minor ailments, effective November 1st, 2018: Conjunctivitis, emergency contraception, erectile dysfunction, hormonal contraceptives, influenza, obesity, shingles, onychomycosis and urinary tract infections
  • Other updates:
    • Conjunctivitis guideline
      • Changed the age recommended for Lodoxamide from 2 year old to 4 years old.  The Canadian labelling is for 4 years and up; we previously had the US labelling of 2 years and up.

June 19, 2018

New prescribing options have been added.  See the updated guidelines for details about these options:
  • Acne: Azelaic acid 15% gel
  • Hormonal contraception: Depo-Medroxyprogesterone Acetate IM
  • Dysmenorrhea: Can prescribe combined hormonal contraceptive as a first-line choice

May 25, 2018

The obesity and erectile dysfunction guidelines are now posted; pharmacists may now prescribe for these conditions.

April 17, 2018

  • UTI guideline: The age restriction for prescribing has changed from 2 years old to 16 years old.  This is due to a literature review conducted by SCPP.
  • Headache guideline: Clarified that among the NSAIDs, only Cambia® is approved for acute migraine treatment.

March 20, 2018

Hormonal contraceptive guidelines: Added "age <12" as a referral criteria - in guideline, PAR, and algorithm.

March 15, 2018

  • Updated UTI guideline (now includes age cut off of <2 years of age, and added pediatric dosing options in the treatment section)
    • PAR and algorithm updated to reflect this
  • Updated shingles guideline (now includes section on pediatrics in treatment section.

February 20, 2018

Guidelines for onychomycosis and influenza have now been posted.  Pharmacists may now prescribe for these conditions.  Optional training is available through CPDPP.

February 6, 2018

Guidelines for shingles and conjunctivitis have now been posted.  Pharmacists may now prescribe for these conditions.

December 6, 2017

Emergency contraception guideline: Added an algorithm that summarizes billing for ulipristal and LNG ECP, under the prescribing and billing details section.

November 20, 2017

Posted guidelines for emergency contraception, hormonal contraception, and urinary tract infections.  Pharmacists may now prescribe for these conditions.

August 24, 2017

Updated MSK and headache guidelines
  • Ibuprofen, Naproxen and Celecoxib have been found to be the lowest risk NSAID in patients with cardiovascular or cerebrovascular concerns.
    • This is new information from the Precision Study. Prior knowledge suggested Naproxen was the safest NSAID for CV concerns.
  • Dosage information for Ibuprofen updated to show maximum dosage for a migraine (3200mg/day)
  • Naproxen sodium and Diclofenac potassium added as eligible products to prescribe for a headache or migraine.

May 1, 2017

Updated all guidelines with some minor changes to terminology
  • Instead of "refer to MD/physician", the terminology "refer to patient's primary care provider", or simply "refer",  is used instead.  This is to reflect there are different eligible prescribers for a particular patient, and they may not necessarily have a regular physician to refer them to.
  • All PARs / Algorithms / Guideline text updated to reflect this change.

April 11, 2017

  • Updated Musculoskeletal sprains / strains guideline
    • Updates PAR and algorithm (changed "Refer to MD" to simply "refer", or "refer to primary care provider"
    • Celecoxib removed as an NSAID of concern in CV disorders; recent evidence supports its relative safety in those with CV concerns.

  • Updated Cold sore guideline
    • Made it more clear on PAR / algorithm / guideline text that pharmacist treatment is only for a recurrent episodes of herpes labialis, NOT a primary infection.

  • Updated Insect bites guideline
    • Added icaridin as a recommended insect repellant in kids and adults

  • Updated superficial bacterial skin infection guideline
    • Before we had the statement that polymyxin/bacitracin containing products were ineffective for impetigo.  Updated to say "these products have little evidence for their use, but may be an option."

February 14, 2017

Updated Allergic Rhinitis guideline
  • Fluticasone deregulated to schedule II (OTC).  This means it is no longer eligible for the prescribing assessment fee.

November 30, 2016

Updated GERD guideline
  • Esomeprazole deregulated to Schedule II for package sizes ≤ 280 mg; added wherever OTC omeprazole appears
  • Algorithm modified so that a patient in Scenario 1 will only receive one 28-day PPI fill so as not to go longer than 56 days without MD or NP assessment.
  • Minor changes and corrections

September 13, 2016

Reminder: Hydrocortisone 1% is OTC, UNLESS the patient is under 2 years of age.  If the patient is under 2, you may prescribe hydrocortisone 1% and bill for the minor ailment assessment fee.  This applies to insect bites, diaper dermatitis, and atopic dermatitis.

August 4, 2016

  • Cold Sore guidelines
    • Acyclovir 5% / Hydrocortisone 1% topical cream (Xerese) is now available for pharmacist prescribing.  See the guidelines for where they fit into therapy.

  • Atopic dermatitis guidelines
    • Beclomethasone dipropionate 0.025% cream (Propaderm) can now be prescribed by pharmacists.  It is a medium potency corticosteroid.

March 23, 2016

Updated Tinea guidelines
  • Corrected a few errors regarding ketoconazole treatment duration among all 3 tineas
  • Updated algorithm and PAR for all 3 tineas
  • No changes to monitoring, treating, or referral criteria

March 15, 2016

Updated superficial bacteria guideline:
  • Added details about rationale for treating impetigo, and risk factors for developing
  • Added pictures
  • Clarified some differential assessments by adding "differentiating factors"
  • Clarified treatment durations to be consistent with new guidelines (5 days for impetigo; 7-10 for folliculitis)
  • Expanded advice/monitoring section
  • Updated PAR and algorithm.  PAR includes new autofill short-form.

March 13, 2016

Updated oral thrush guideline:
  • Aligned the red-flags for referral to be consistent with current recommendations
  • Added risk factors for thrush to "Description" section
  • Added three types of thrush under "Signs and symptoms" section
  • Added leukoplakia and aphthous ulcer as differential diagnoses
  • No changes to treatment or monitoring recommendations
  • Aligned algorithm and PAR to be consistent with the guidelines
  • PAR now has the new auto-fill short-form
  • Overhauled algorithm and PAR

March 8, 2016

Updated oral aphthous ulcer guideline:
  • Added minor, major and herpetiform ulcer symptoms
  • Significant update to "When to Refer" section to better align with current guidelines
  • Added a few non-pharmacologic treatments.  Other treatments remain unchanged.
  • Added directions for using triamcinolone dental paste
  • Added OTC product table to product section
  • Significant content and format changes to algorithm (to better reflect changes to the when to refer section)
  • Significant content and format changes to PAR (including the new auto-fill short-form)

March 5, 2016

Updated Hemorrhoids guideline:
  • Added goals of therapy under treatment
  • Added when to choose certain formulations (ointment vs. suppository) under treatment
  • Added OTC product table under "products"
  • Updated algorithm to be consistent with other guidelines
  • Updated PAR: includes new auto-fill short-form, which can be sent to the doctor as the required documentation.

March 3, 2016

Updated Musculoskeletal Strains and Sprains
  • Added "grades" of sprains and strains to description section
  • Signs and symptoms section expanded to include how to do an assessment
  • Expanded RICE therapy section under treatment
  • Monitoring, OTC and Rx options remain unchanged
  • Updated algorithm to be consistent with other guidelines
  • Updated PAR: includes new auto-fill short-form, which can be sent to the doctor as the required documentation.

February 25, 2016

Updated headache guideline:
  • Added signs and symptoms for cluster headache
  • Added details of questions to ask the patient
  • Updated diagnosis of migraine and medication-overuse headache according to newest IHS guidelines
  • Added drug interaction info for triptans
  • Added section on how to choose the best triptan for a particular patient under treatment
  • Added details to monitoring/follow up
  • Revised PAR and algorithm to standard format.  PAR includes new auto-fill short-form, which can be sent to the doctor as the required documentation.

February 11, 2016

Updated dysmenorrhea guideline:
  • Expanded differential assessment section by including several other conditions
  • Clarified some of the red flags
  • Added non-pharm and more OTC treatment options
  • Expanded monitoring section by adding goals of therapy
  • Major revisions to algorithm to be more clear and reflect current guidelines
  • Updated PAR to include above changes and the new auto-fill short form, which can be sent to the doctor as the required documentation.

February 8, 2016

Updated diaper dermatitis guideline:
  • Added risk factors and epidemiology to description
  • Added more red flags for referral to be consistent with current guidelines
  • Minor updates and corrections to other sections
  • Clarified treatment duration (7days + 7 at follow up if some improvement)
  • Revised algorithm to be more clear and consistent with standard format, and newest guidelines
  • Updated PAR to include revision and the new autofill short-form.

February 4, 2016

Updated Cold Sore guideline:
  • Added risk factors and triggers to description section
  • Added transmission info under signs and symptoms
  • Clarified details with some differential assessment conditions
  • Aligned red-flags for referral with other guideline recommendations:
    • Removed age limit of <12 years.  Can prescribe acycvloir if between 2 and 12
    • Removed renal dysfunction as a red flag
    • Added frequent recurrences (>6 per year), as prophylaxis is more appropriate
  • Added renal and pediatric dosing to treatment section
  • Clarified when oral antiviral prescriptions are appropriate.
  • Updated algorithm to modern format and some content changes to be more clear.
  • Updated PAR form, including a short-form that is automatically filled in.  This short-form is all you need to send to the patient's doctor to comply with the requirements of the program.

February 1, 2016

Updated Atopic Dermatitis guideline:
  • Updated signs and symptoms to include primary and secondary atopic dermatitis, as well as acute and chronic differentiation
  • Added some details to description section, including risk factors
  • Added more conditions (tinea corporis, cutaneous T-cell lymphoma, drug-induced) to the differential assessment section
  • Added goals of treatment to treatment section
  • Added more details about non-pharmacologic methods of optimal skin care
  • Added more patient counselling tips and monitoring parameters
  • Updated algorithm to standardized format
  • Updated PAR form, including a short-form that is automatically filled in.  This short-form is all you need to send to the patient's doctor to comply with the requirements of the program.

January 28, 2016

Updated Allergic rhinitis guideline:
  • Definition of intermittent and persistent updated to match new guidelines from American Academy of Otolaryngology
    • Intermittent: symptoms <4 days per week and <4 weeks consecutive
    • Persistent: symptoms  >4 days per week and >4 weeks consectuvie 
    • Algorithm and PAR also updated to reflect this change

  • Updated PAR form, including a short-form that is automatically filled in.  This short-form is all you need to send to the patient's doctor to comply with the requirements of the program.

January 26, 2016

Updated Acne guideline:
  • Most notable content change:  non-pharmacologic therapy for 8 weeks no longer required before proceeding to prescription treatment
  • Updated algorithm
  • Updated PAR form, including a short-form that is automatically filled in.  This short-form is all you need to send to the patient's doctor to comply with the requirements of the program.

August 19, 2015

Superficial bacterial infections (Impetigo, folliculitis):
  • New impetigo guidelines from IDSA recommend treatment duration of 5 days with mupirocin (down from 7 days)
  • New data provides conflicting evidence whether removal of impetigo crusts is necessary for antibiotic absorption.
  • Updated the guidelines, algorithm and PAR to reflect this new information.

May 12, 2015

Cold sores
  • Clarified the assessment section of the PAR, eg. when you can prescribe or not
  • Added option to prescribe acyclovir suppressive therapy if anticipated exposure to a trigger coming (eg. prolonged sun exposure) -- updated on PAR, algorithm and main guideline.

April 6, 2015

  • GERD: OTC omeprazole (20 mg) added to algorithm and guidelines information
    • Included in OTC options
    • Information in guidelines about using  OTC as on-demand or intermittent therapy in subsequent episodes
  • GERD:  More clearly defined timelines for discrete recurrences and potential rebound symptoms; incorporated into algorithm and PAR
  • Allergic Rhinitis: removed triamcinolone acetonide from prescription options

March 9, 2015 (clarified Sep 13, 2016)

Removed hydrocortisone 1% as prescription options for insect bites, diaper dermatitis and atopic dermatitis for patients over 2 years of age.
  • PARs and algorithms updated
  • If the patient is under 2 years of age, hydrocortisone 1% is still a prescription product, thus you can bill a minor ailment assessment fee for that product.

December 18, 2014

Dysmenorrhea, Headache and Musculoskeletal pain guidelines:
  • Added more detailed description of cardiovascular / cerebrovascular concerns when prescribing NSAIDs or triptans under "Treatment" section for all three guidelines
  • Updated PAR to included cardiovascular / cerebrovascular disease recommendations

October 7, 2014

  • Added new safety information about NSAIDs, particularly diclofenac, in the headache, dysmenorrhea and musculo-skeletal pain guidelines.
  • New dosing maximum for diclofenac in headache, dysmenorrhea, and musculo-skeletal pain guidelines.

September 30, 2014

Clarified "review of symptoms" section on atopic dermatitis in the PAR

July 29, 2014

  • Guideline updates will now be tracked and posted here
  • Added a "billing details" section to all guidelines, which includes:
    • The pseudoDIN to bill the assessment fee to the drug plan (pseudoDIN also now appears in the PAR)
    • Quantity and refill limits (also now appears in the PAR)
    • Any other prescribing details specific to a condition will be listed in this section
  • Removed brand-specific DINs from "products" section.  Only active ingredients approved for the minor ailment will be listed.