The University of Southampton
Medicine

Research Group: Primary care Research group

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The Primary Care Research Group strengths are in acute infections, mental health problems, and complementary and integrative medicine.

Group Overview

Primary Care Research
Primary Care Research

Research focus

The Southampton Primary Medical Care research group offers a broad spectrum of expertise in both methodologies and topic areas. We doubled in size between the 2008 Research Assessment Exercise and the 2014 Research Excellence Framework assessment, in which 87% of our research was rated as ‘internationally excellent’ or ‘world-leading’. In the Public Health, Health Services, and Primary Care unit of assessment, we were ranked 3rd highest for the quality of our research outputs out of 32 institutions.

Since 2008 the Primary Care Research Group has built on our existing strengths in acute infections, mental health problems, and complementary medicine. We continue to develop new directions for our antibiotic research, – in particular research into lower and upper respiratory tract infections including influenza, as well as urinary tract infections. Our strategy has been to enhance diagnostic clarity and self-care, better understand prognosis, minimise the medicalization of self-limiting illness and reduce the risk of antibiotic resistance through more targeted use of antibiotics.

Other research focuses on mental health research particularly in the areas of assessment and management of common mental health problems (e.g. delineating distress from depression and anxiety, monitoring depression, and developing algorithms for antidepressant use). Our research showed that GP performance indicators for the assessment of severity of depression at diagnosis and follow-up were associated with better targeted treatments and referrals.

We also continue to develop large robust trials of non-pharmacological approaches to chronic disease management (e.g. MBSR, CBT-based guided self-help) to extend web-based interventions to population settings (e.g. for obesity in Teeside); to different platforms (such as mobile phones); and to other common conditions (e.g. back pain, asthma, and distress). The group has worked in developing and evaluating web-based interventions promoting lifestyle change (e.g. for obesity, hypertension) and self-management of common conditions (e.g. dizziness, chronic fatigue syndrome, hypertension, irritable bowel syndrome (IBS), childhood eczema, and distress, funded from the NIHR Research for Patient Benefit (RfPB), HTA, and SPCR programmes. Having piloted effective websites, large MRC- and HTA-funded trials are underway for infection transmission, obesity and IBS.

Key achievements

Following landmark trials developing open pragmatic trial methodology for prescribing strategies in sore throat, otitis media and acute cough, we developed and trialled clinical prediction rules, dipstick ‘rules’ and delayed prescription for urinary tract infection (UTI), demonstrating modest reduction in antibiotic use was possible.

A high profile trial demonstrated the limited impact of both antibiotics and nasal steroids for rhino-sinusitis.

The largest placebo-controlled trial to date in acute chest infections demonstrated that when pneumonia is not suspected clinically, antibiotics provide little benefit for acute lower-respiratory-tract infection in primary care, both overall and in patients aged 60 years or more, and cause slight harms.

We showed that the inclusion of GP performance indicators for the assessment of severity of depression at diagnosis and follow-up was associated with better targeted treatments and referrals, in multi-practice observational studies

The analysis of GPRD data (from 170 practices over 13 years) showing that the rise in antidepressant prescribing is due to increases in the proportion of patients on long-term medication rather than any increase in the rate of diagnosis of incident depression, and pointing to the need to research longer term prescribing in primary care as well as the initial decision to prescribe.

In another study, acupuncture was evaluated for managing osteoarthritic pain, and contributed to individual patient data meta-analysis of acupuncture for chronic back pain, showing it is effective and a reasonable referral option. Significant differences between true and sham acupuncture indicated that acupuncture is more than a placebo. However, the differences are modest, suggesting that other factors besides needling contribute to its effects.

Our research addresses the feasibility of early identification of alcoholic liver disease in primary care and intervention based on feedback of liver disease risk, and have British Liver Trust funding for a new feasibility study for more extensive identification of liver risk using fibrosis markers in primary care.

We are are building on a successful web-based behavioural intervention for obesity, developing an integrated obesity and alcohol intervention for those at risk of cirrhosis due to the combined effects of alcohol and fatty liver, linking with the NIHR Nutrition BRC.

Collaborations and enterprise

We are working on the development of an algorithm to inform clinical decision making about starting antidepressants in primary care, through an NIHR PGAR-funded cohort and trial with UCL, Bristol, York and Liverpool

We have evaluated the Alexander Technique (AT) for chronic/recurrent back pain (MRC ATEAM) study with Bristol followed by the NIHR Efficacy and Mechanism Evaluation (EME) funded ASPEN study. Having demonstrated that AT is cost-effective, we are evaluating the additive effect of physiotherapy and exploring recovery mechanisms.

The group has evaluated risk stratification of liver disease risk using non-invasive markers. We have set up a cross-Faculty research group (the Wessex Alcohol Research Centre) with strong patient and public involvement (PPI).

We lead the multicentre SCPR CANDID lung and colorectal cancer cohort and ATAFUTI trial of alternative treatments for adult female UTIs and are key collaborators in the SPCR BARACK-D trial of aldosterone receptor antagonism in chronic kidney disease; DUTY cohort of diagnosis of UTI in children and TARGET cohort on childhood respiratory infection prognosis.

GRACE consortium projects include the R-GNOSIS trial of near-patient tests for UTI, and two of the largest trials of antibiotic.

Research Staff

Related Projects

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