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Evidence-based decision-making for primary care: The interpretation and role of pragmatic trials.

In the era of evidence-based medicine, health authorities are obligated to base policies on solid evidence. The gold standard of evidence-based medicine is the randomised controlled trial (RCT) in which participants fulfil strict criteria for inclusion, and the ecology of care – i.e. factors other than the intervention that could influence the outcome are controlled.[1] However, evidence supporting systems interventions in health services that involve multiple changes in the delivery of services is complex and requires the synthesis of evidence from multiple sources. Not surprisingly, such evidence is scarcest in the resource-constrained settings that need it most, where issues of prioritisation and cost-effectiveness are of paramount importance.