For the reader it may be helpful to think of a sliding scale, moving from a highly controlled explanatory trial to a clinically-orientated pragmatic trial
are designed to reflect "real-world" medical care by recruiting broad populations of patients, embedding the trial into the usual healthcare setting and leveraging data from health systems to produce results that can be readily used to improve patient care.)
Likely what is needed is an "all of the above" approach: more pragmatic trials
to evaluate proven therapies and their combinations in real-world settings; efforts to reduce the use of low-value services, such as payer coverage policies based on guideline recommendations; patient engagement through shared decision making; and pressure on insurers to cover nonpharmacologic, noninvasive therapies that have shown benefit.
If pragmatic trials
or high-quality prospective observational studies are completed and published over the next decade, an improved evidence base may help clinicians and public health planners decide on the most appropriate use of oseltamivir and potential new influenza antiviral agents for patients with severe infections caused by seasonal or pandemic influenza.
For instance, the Knowledge Translation Unit at the University of Cape Town has conducted pragmatic trials
evaluating outreach education and task shifting of care from doctors to other health professionals, compared with standard care for implementing guidelines for respiratory conditions, including tuberculosis and more recently HIV.
Other prerequisites for real-world pragmatic trials
are scientific excellence, therapy area expertise, the scope and scale of operations to efficiently execute studies, expertise in clinical trial design and health economics and outcomes research (HEOR), as well as a knowledge of related regulatory requirements and guidelines.
Two pragmatic trials
of treatment for shoulder disorders in primary care, general ability, course, and prognostic indicators.
preference trials, pragmatic trials
) methods and designs for health intervention research.
to give appropriate weight to health services methods such as pragmatic trials
and observations methods," according to Wardle and Oberg.
DaVita Clinical Research uses its applied database and healthcare experience to assist pharmaceutical and medical device companies in the design, recruitment, and completion of clinical trials including retrospective and prospective pragmatic trials
cluster trials, non-inferiority and equivalence trials, and pragmatic trials
), interventions (i.e.