Pragmatic trials and implementation science: grounds for divorce?

Background: The paper opens with a brief history of two of the major intellectual components of the recent utilitarian turn in clinical research, namely 'pragmatic trials' and 'implementation science'. The two schools of thought developed independently and the paper scrutinises their mutual compatib...

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Publicado en:BMC Medical Research Methodology Vol. 19; no. 1
Autor principal: Pawson, Ray
Formato: Journal Article
Publicado: BioMed Central 8/16/2019
Acceso en línea:Ver este registro en EBSCOhost
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      dt: 8/16/2019
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      pub: BioMed Central
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        10.1186/s12874-019-0814-9
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        atl: Pragmatic trials and implementation science: grounds for divorce?
      aug:
        au: Pawson, Ray
        affil: School of Sociology and Social Policy, University of Leeds, LS2 9JT, Leeds, UK
      sug:
        subj:
          Research, Medical Methods
          Study Design
          Randomized Controlled Trials Methods
          Professional Practice, Evidence-Based Methods
          Research, Medical Standards
          Professional Practice, Evidence-Based Standards
          Randomized Controlled Trials
          Randomized Controlled Trials Standards
          Reproducibility of Results
          Research, Medical
          Professional Practice, Evidence-Based Statistics and Numerical Data
          Clinical Assessment Tools
          Scales
      ab: Background: The paper opens with a brief history of two of the major intellectual components of the recent utilitarian turn in clinical research, namely 'pragmatic trials' and 'implementation science'. The two schools of thought developed independently and the paper scrutinises their mutual compatibilities and incompatibilities, asking: i) what do the leading advocates of pragmatic trials assume about the transfer of research findings to real-world practice and ii) what role pragmatic trials can and should play in the evaluation of implementation science strategies.Methods: The paper utilises 'explication de texte': i) providing a close reading of the inferential logics contained in major published expositions of the two paradigms, and ii) interrogating the conclusions of a pragmatic trial of an intervention providing guidelines on retinal screening aimed at family practitioners.Results: The paper is in two parts. Part 1 unearths some significant incommensurability - the pragmatic trial literature retains an antiquated view of knowledge transfer and is overly optimistic about the wide applicability the findings of pragmatic trials to 'real world' conditions. Part 2 of the paper outlines an empirical strategy to better penetrate the mechanisms of knowledge transfer and to tackle the issue of the generalisabilty of research findings in implementation science.Conclusions: Pragmatism, classically, is about problem solving and the melding of perspectives. The core research requirement in implementation science is a fundamental shift from the narrow shoulders of pragmatic trials to a model of explanation building based upon a multi-case, multi-method body of evidence.
      pubtype: Academic Journal
      doctype: Journal Article
      ougenre: Article
    language: English
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