Use of Directly Observed Therapy to Assess Treatment Adherence in Patients With Apparent Treatment-Resistant Hypertension

to nurse practitioners and physician assistants, prescribing decisions may involve pharmacists; registered nurses who may supervise treatment of chronic disease, implement standing orders, and educate patients about new therapies; and procedural nurses who may arrange visits from medical device representatives and oversee purchasing. In Australia, Karanges et al found that many nonphysicians received speaking fees, highlighting their influential role. 3 The expansion of the Sunshine Act in the United States to include additional prescribing clinicians is a welcome development, although still several years away. The Australian experience with broader reporting of industry payments to health care professionals suggests that the forthcoming data should be illuminating. The next steps are to move from greater transparency to reforms that address the high costs of medical care and diminish the incentives for industry payments to health care professionals in the first place.