We all know that clinical trials are one of the best ways to decide whether interventions work, which is why they are considered the gold standard in evidence-based medicine.
However, healthcare practitioners, commissioners and, indeed, patients are often more interested in how interventions actually perform in the real world. It is certainly true that the day-to-day treatment of patients who are seen in hospitals and practices is very different from clinical trial settings because trial consent processes and inclusion/exclusion criteria mean that certain high risk populations, including the elderly, incapacitated and multimorbid, are often excluded.
This is where, in my view, real-world evidence can be most valuable. Large real-world studies complement clinical trials by allowing us to study the safety, tolerability, clinical and cost-effectiveness of treatments in a comprehensive range of patients. They also allow us to evaluate a wider range of outcomes over a longer time period.
While we should not seek to replace clinical trials, I believe that we can learn a lot from real-world evidence.