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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often characterized by their focus on practical aspects of designing a study, including the recruitment and consent process, as well as adherence and the use of standard equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, 프라그마틱 환수율 which used a variety of investigators and participants from various geographical areas. This type of heterogeneity which is vital for a pragmatic trial to be reliable and to reduce bias in the results, is also necessary. A high degree of heterogeneity, however can result in problems with the design of the trial.

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The goal of pragmatic trials is to simulate real-life scenarios and gain maximum credibility externally. They are usually commissioned by practitioners and policy makers to guide their decision-making. They also provide a useful method to determine the causal relationship between an intervention and its outcomes. However, they shouldn't be used in lieu for explanation trials.

The concept of pragmatism is controversial, and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 made a distinction between explanatory studies, which support a physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in the decision-making process for policy and practice. They also proposed an approach to pragmatic trials, which they called PRECIS.2 This tool attempted to define the features of a pragmatic trial, including recruitment, design and delivery of the intervention, and monitoring.

There is a positive trend in the number of pragmatic trials that are published. A recent Medline search using the terms naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatic thinking. However, it is important to remember that the majority of these trials were conducted in primary care settings.