A narrative review completed by GetReal examined the literature related to the concept of the efficacy-effectiveness gap (Nordon et al., 2016). The authors used inductive analysis to identify the different ways, here called ‘paradigms’ used to understand the efficacy-effectiveness gap (see Clarify the Issues) that have evolved over the last few decades. These are summarised in the table below.
|1. Method used to assess the effects of a medicine||
|2. Impact of patient and clinician’s behaviour or real-life characteristics of the healthcare system||
|3. Interaction between a medicine’s biological effect and contextual factors||
Current view on the efficacy-effectiveness gap
The third and current paradigm provides the opportunity to look beyond the differences between ‘standardised’ and ‘real-life’ characteristics of the healthcare system and study designs. Many experts consider there to be a continuum between explanatory and pragmatic trials, rather than a simple dichotomy: explanatory vs pragmatic: ‘the explanatory‑pragmatic continuum’. Future research will determine if the identification of these contextual factors can help to design RCTs that provide better estimates of medicines’ effectiveness.
Clementine Nordon, LASER