Two main areas of interest: health promotion and the management of common self-limiting illnesses. These topics link evidence about effectiveness with the effect of management of patient beliefs and behaviour, better understanding the importance of the patient centred approach to the consultation.
This was an MRC funded trial of the Alexander Technique (a technique to improve and modify poor postural and body ‘use’ habits) and exercise prescription by GPs for back pain (the ATEAM trial). It demonstrated significant benefits for pain and function in the longer term.
Following the ATEAM trial EME have now funded this study to investigate the mechanisms of Alexander Technique and the mechanism of recovery in back pain with both physiotherapy and the Alexander Technique.
ARC Fellowship (Lisa Roberts)
I am co-investigator and mentor for this project which aims to understand communication in physiotherapy consultations and will then develop and pilot and intervention to modify consultation behaviour.
Internet based behaviour support
A major focus of interest is in developing internet based behavioural support for a range of conditions:
Obesity (the HTA funded POWeR trial)
Hypertension (SMILE trial, funded by the National School for Primary Care Research)
Infection transmission (The MRC PRIMIT trial)
Irritable bowel syndrome (NIHR funded, lead by Hazel Everitt)
Eczema (NIHR funded, lead by Miriam Santer)
The management of common infections
Following our work in trialling antibiotic prescribing strategies in several respiratory infections we have also recently completed a study to develop clinical scoring algorithm for urinary tract infections leading to a trial of different management approaches.
We have just completed two major trials as part of a large European Union Network of Excellence project (GRACE) for Lower respiratory tract infection - which is the commonest acute condition managed in primary care.
RCT of amoxicillin: this trial which is coming to a close has randomized 2061 individuals in 12 Networks across Europe and the results are likely to dominate the management of lower respiratory tract infection (LRTI) in primary care for some time.
The second GRACE trial developed from another EU project we share (CHAMP), developed and tailored web based communication training packages for health professionals in 6 EU countries. We randomized 246 practices across Europe and recruited more than 4000 patients in this trial - which assessed whether an internet based behavioural intervention to modify communication in the consultation can modify health professional antibiotic prescribing for LRTI.
This is a large prognostic cohort study in acute sore throat (more than 13000 patients have been recruited) funded by the MRC.
This is an HTA funded study to develop and perform a randomized trial (which has recruited more than 1500 patients) of strategies for using rapid tests and clinical scores for sore throat.
The MRC have funded us to develop and trial an infection control website requiring complex intervention development.
An MRC studentship was used to develop web based self help advice using the MRC Framework for the development of complex interventions.
NIHR PRIME Programme grant
This supports several studies on the management of acute and recurrent infections:
PIPS: steam, paracetamol and ibuprofen for acute respiratory infections.
SNIFS: nasal irrigation and steam for recurrent sinusitis.
TASTE: probiotics and xylitol for recurrent sore throat.
3C’s study (Cough Complication Cohort): a large prospective cohort similar to DESCARTE but for LRTI
Internet Dr trial (following the development referred to above).
Primary Care & Population Sciences Academic Units
Affiliate academic unit(s)
Primary care Research group
We are looking to investigate the usefulness of antibiotics in this age group, it follows a European wide trial that was very similar for adults. Children will be provided antibiotic or placebo and keep a symptom diary for up to 28 days. They can opt to provide a throat swab, a blood sample and have a chest x-ray.
Although effective medicinal treatment exists for asthma, many people continue to have distressing symptoms and impaired quality of life. People with asthma have expressed interest in non-drug asthma treatments, particularly in breathing exercises. Several recent studies have shown benefits from a short course of breathing exercises taught by a respiratory physiotherapist for people with asthma who remained symptomatic despite usual treatment. We believe that many NHS patients could potentially benefit from these exercises, but unfortunately, there is currently not enough access to suitable trained physiotherapists able to provide such a service. We propose to provide the same breathing training programme that we have previously shown to be effective when taught 'face-to-face' by a physiotherapist in the form of a DVD, or internet download. Patients will use this in their own home at times convenient to them, in addition to their standard treatment (e.g. with inhalers). We will find out whether this type of instruction is better than the 'usual care' that is currently provided, and whether it is as good as the 'face to face' physiotherapist instruction (which is more expensive and less convenient for patients).
There is considerable concern about increasing antidepressant use in England. GPs are giving out more than 50 million prescriptions a year, to more than 1 in 10 adults.
Developing a nurse-delivered behavioural intervention to support weight loss in obese adults
The DIPSS (Integrating Digital Interventions into Patient Self-Management Support) project has received funding of £2 million from the NIHR to examine patient digital self-management with healthcare professional support in primary care. Our aim is to develop digital behaviour change interventions for asthma and hypertension self-management, which will be examined in feasibility studies and full RCT (hypertension only). Issues surrounding the feasibility, acceptability, effectiveness and cost-effectiveness of digital intervention delivery will be explored with patients and healthcare professionals for each condition.
Professor Paul Little
Primary Medical Care Aldermoor Health Centre Aldermoor Close Southampton SO16 5ST
Room Number:9590 AHC//S2