The opportunities and challenges of pragmatic point-of-care randomised trials using routinely collected electronic records: evaluations of two exemplar trials

The health-care system aims to provide evidence-based medicine with care informed by research, in addition to that reflecting patients' values and preferences. Randomised trials are considered the best approach to learn about the effects of many health-care interventions. However, routinely used interventions often lack evidence to guide clinicians to recommend an intervention for a particular patient. This uncertainty can relate to the lack of trial evidence of comparative effectiveness or to the fact that the patient would not have been eligible for previous trials (e. g. due to comorbidity). Many clinicians agree that they have a duty to work with colleagues and patients to help resolve uncertainties about the effects of treatments. This project outlines a possible method to help clinicians and patients to conduct simple randomised trials using routinely collected data.