Research interests
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.
Health promotion
Back Pain
ATEAM trial
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.
Internet based behaviour support
A major focus of interest is in developing internet based behavioural support for a range of conditions:
RECON (PGfAR programme to limit cognitive decline)
CLASP (PGfAR programme to support cancer survivors)
Obesity (the HTA funded POWeR trial)
RECUR (PGfAR Programme for recurrent infections)
Hypertension (SMILE trial, funded by the National School for Primary Care Research)
Infection transmission (The MRC PRIMIT trial)
Irritable bowel syndrome (NIHR funded, led by Hazel Everitt)
Eczema (NIHR funded, lead by Miriam Santer)
The management of common infections
UTIS study
Following our work in trialling antibiotic prescribing strategies in several respiratory infections we completed a study to develop clinical scoring algorithm for urinary tract infections leading to a trial of different management approaches.
GRACE
We 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 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.
GRACE INTRO
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.
DESCARTE
This was a large prognostic cohort study in acute sore throat (more than 13000 patients were recruited) funded by the MRC.
PRISM
This was 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.
PRIMIT
The MRC funded us to develop and trial an infection control website requiring complex intervention development.
Internet Dr
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 supported 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).
Please visit the Primary Care website.
Department(s)
Primary Care, Population Sciences and Medical Education
Affiliate Department(s)
Research project(s)
Infectious diseases are a major threat to human wellbeing and economic and social development. Influenza, a highly contagious virus, causes a common respiratory infection with local and systemic symptoms.
Many patients in primary care are being prescribed antibiotics to treat mild infections such as colds, earaches and sore throats. Many of these are viral rather than bacterial infections that get better on their own and which can be treated with self-care (such as rest, fluids and mild pain killers).
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).
This programme of research aims to promote effective eczema self-care by improving individuals’ knowledge of eczema treatments and influencing attitudes, skills, and habits related to treatment use.
The overuse and misuse of antibiotics in primary care is an increasing national and global concern due to the increasing risk of antimicrobial resistance (AMR) (when bacteria becomes resistant to treatments leading to increased risks of illness lasting longer, increased symptom severity and even death).
The population is getting older (over 3 million people [5%] in the UK are >80 years) and the number of people living with multiple long-term conditions taking multiple drugs is increasing. High blood pressure is one of the most common conditions in older patients and up to half of this population receive two or more drugs to treat it. However, recent evidence suggests that large reductions in blood pressure, and too many drug prescriptions may be associated with an increase in serious falls and death in the elderly.
This is a retrospective cohort study to investigate the long-term effects of prolonged antibiotic consumption on health.
This is a survey about what people have done to try and prevent and treat Covid-19 since the start of the pandemic.
Acute sinus infections are one of the commonest infections managed in primary care, Currently GPs prescribe antibiotics to most patients presenting with sinusitis, the highest of any of the common acute infections presenting in adults, at over 90%.
In the SupportBack 2 trial we aim to find out if an internet intervention, with or without physiotherapist support, can be effective in helping primary care patients manage low back pain.
A primary care trial of a website based infection control intervention to modify influenza-like illness and respiratory infection transmission.
Developing a nurse-delivered behavioural intervention to support weight loss in obese adults
Assessing Cognitive behavioural Therapy in Irritable Bowel Syndrome (ACTIB)
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.
This project is exploring different ways of providing long term follow up to cochlear implant users.
Professor Paul Little CBESchool of Primary Care, Population Sciences and Medical Education
Aldermoor Health Centre
Aldermoor Close
Southampton
SO16 5ST
Room Number: 9590 AHC/145/S2
Telephone:(023) 8059 1791
Facsimile:(023) 8070 1125
Email:P.Little@soton.ac.uk
