Broadening the Responsibilities of Practitioners

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Abstract
THE previous article described how a large health maintenance organization (HMO), Kaiser Permanente of Southern California (KPSC), developed a guideline for the use of intravenous radiographic contrast agents for low-risk patients.1The principal issue was whether the lower rates of reactions with low osmolar contrast agents (LOCAs) were worth their higher costs compared with high osmolar contrast agents (HOCAs). After estimating the magnitudes of the risks and costs, KPSC determined that they were not; the same resources could provide greater overall benefit to its members if put into other activities, such as screening for cancers of the cervix or breast. The final guideline stated: "For procedures involving intravenous administration, patients who can be determined to be at low risk of having a reaction should receive HOCAs. Patients who have risk factors for a reaction should receive LOCAs." The full guideline contains more details about specific risk factors and pretreatment

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