The value of pragmatic and observational studies in health care and public health

Maxwell S Barnish* (Corresponding Author), Steve Turner

*Corresponding author for this work

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Evidence-based practice is an important component of health care service delivery. However, there is a tendency, embodied in tools such as GRADE, to focus principally on the classification of study design, at the expense of a detailed assessment of the strengths and limitations of the individual study. Randomized controlled trials (RCTs), and in particular the classical ‘explanatory’ RCT have a privileged place in the hierarchy of evidence. However, classical RCTs have substantial limitations, most notably a lack of generalizability, that limit their direct applicability to clinical practice implementation. Pragmatic and observational studies can provide an invaluable perspective into real-world applicability. This evidence could be used more widely to complement ideal-conditions results from classical RCTs, following the principle of triangulation. In this review article, we discuss several types of pragmatic and observational studies that could be used in this capacity. We discuss their particular strengths and how their limitations may be overcome, and provide real-life examples by means of illustration.
Original languageEnglish
Pages (from-to)49-55
Number of pages7
JournalPragmatic and Observational Research
Publication statusPublished - 12 May 2017


  • research methods
  • randomized controlled trials
  • pragmatic trials
  • observational studies
  • disease registries
  • evidence-based medicine


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