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To the Editor.—The Users' Guide to the Medical Literature by Dr Dans and colleagues¹ for assessing the applicability of clinical trials to a clinician's own patients represents an important advance in the ongoing effort to improve the usefulness of clinical research. However, the authors omitted one of the most common and important characteristics that determines applicability: the health care setting in which the patient is seen. While many important clinical trials are conducted in tertiary care settings, most clinical care is provided in primary care settings. Although the guides presented in the article by Dans et al can facilitate assessment of applicability of these trials to primary care, it is important to identify the specific ways in which primary care patients and practice differ from tertiary care and how these differences may affect applicability.

Patients seen in primary care settings compared with patients seen in tertiary care settings are . . . [Full Text of this Article]

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