ORIGINAL RESEARCH
Winston Liaw, MD, MPH; Thomas F. Northrup, PhD; Angela L. Stotts, PhD; Christine Bakos-Block, PhD, LCSW; Robert Suchting, PhD; Alvin Chen, BS; Abigail Hernandez, BS; Lisandra Finzetto, BA; Charles Green, PhD; Thomas Murphy, MD
Corresponding Author: Winston Liaw, MD, MPH; Department of Health Systems and Population Health Sciences - University of Houston Tilman J. Fertitta Family College of Medicine.
Email: winstonrliaw@gmail.com
DOI: 10.3122/jabfm.2022.220349R1
Keywords: Clinical Trials, Family Medicine, Mental Health, Primary Health Care, Quality of Life, Referral and Consultation, Social Determinants of Health
Dates: Submitted: 10-11-2022; Revised: 12-08-2022; Accepted: 12-09-2022
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PURPOSE: The purpose was to determine whether an immediate referral to a medical-legal partnership (MLP), compared to a 6-month waitlist control, improved mental health, health care utilization, and quality of life.
METHODS: Conducted in a primary care clinic, this trial randomly assigned individuals to an immediate referral or a wait-list control. The MLP involved a collaboration between the clinic and a legal services organization. The primary outcome was stress (6 months) as measured by the Perceived Stress Scale (PSS; 0-40). Secondary measures included the Center for Epidemiologic Studies Depression Scale (CES-D; 0-60), Generalized Anxiety Disorder scale (GAD-7; 0-21), Patient-Reported Outcomes Measurement Information System (PROMIS), and emergency department (ED), urgent care, and hospital visits. Assessments were at baseline, and 3-, 6-, and 9-month follow-ups. Bayesian statistical inference and a 75% posterior probability (PP) threshold were used to identify noteworthy differences.
RESULTS: Immediate referral was associated with lower PSS scores (18.8 vs. 19.9; PP=74.8%) and higher GAD-7 scores (10.3 vs. 6.7; PP=89.8%). PROMIS scores were higher for the immediate referral group with respect to the pain (b = 7.05; PP=86.9%), social function (b=-6.26; PP=74.9%), fatigue (b=8.20; PP=82.5%), anxiety (b=6.15; PP=85.3%), sleep disturbance (b=4.06; PP=77.8%), and depression (b=4.55; PP=79.3%) subdomains. At 6-months, the immediate referral group demonstrated 21% fewer ED visits (rate ratio (RR)=0.79; PP=79.7%) and 75.6% more hospital visits (RR=1.76; PP=88.5%).
CONCLUSION: Immediate referral to the MLP was associated with lower stress and a lower rate of ED visits but higher anxiety and a higher rate of hospital visits.