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Pragmatic trials are studies designed to inform real-world clinical practice. They are often focused on the practical aspects of the study design, including the recruitment and consent process in adherence, as well as the use of routinely available equipment.

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A pragmatic study that involves different investigators and participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity, which is vital for a pragmatic trial to be valid and to reduce bias in the results is also essential. Too much heterogeneity, however, can cause problems with the design of the trial.

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The purpose of pragmatic trials is to mimic real-life scenarios and to achieve maximum validity externally. They are typically commissioned by policy makers and practitioners to inform their decision making. They can also be used to determine the causal relationship between an intervention and its results. They should, however, not, be used to replace the need for explanation studies.

The concept of pragmatism is controversial, and there are questions about whether pragmatic trials should replace explanatory tests or if they are an alternative to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which confirm the validity of a clinical or physiological hypothesis as well as pragmatic trials, which inform the policy and practice of. They also suggested the framework for pragmatic trials, which they called PRECIS.2 This tool attempted to define the elements of a pragmatic study that include the recruitment process, the design and implementation 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, limited to controlled trials that are randomized (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This indicates that the health science community is becoming more acquaint to the subject of pragmatism. However, it is important to remember that the majority of these studies were conducted in primary care settings.