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April 2015

Understanding Adherence Requires Pragmatic Trials: Lessons From Pediatric Asthma

Author Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2015;169(4):310-311. doi:10.1001/jamapediatrics.2014.3661

Adherence to medications is critical but often suboptimal in asthma and other chronic diseases.1 Intervention studies, particularly those that reflect the real world, are essential for understanding and addressing adherence because it is the real-world setting that defines the barriers to adherence. However, most studies are observational and those that are interventions are frequently efficacy rather than effectiveness or pragmatic trials. Efficacy studies are conducted under tightly controlled conditions that do not reflect how daily medications are taken by patients, which explains why it is not uncommon for their findings to lack significance when attempts are made to replicate results in effectiveness studies.2 Patient-centered, real-world pragmatic research is so important that the Patient-Centered Outcomes Research Institute was established to ensure the conduct of such research,3 the National Heart, Lung, and Blood Institute is considering creating a research consortium to promote this research,4 and the National Institutes of Health offer funding in dissemination and implementation for the adoption of efficacy studies to the real world.5 These are only a few of the ongoing efforts encouraging such research.