ORIGINAL RESEARCH
Winston Liaw, MD, MPH; Christine Bakos-Block, PhD, LCSW; Thomas F. Northrup, PhD; Angela L. Stotts, PhD; Abigail Hernandez, BS; Lisandra Finzetto, BA; Pelumi Oloyede, BS; Bruno Moscoso Rodriguez, BA; Skye Johnson; Lauren Gilbert, PhD, MPH; Jessica Dobbins, DrPH; LeChauncy Woodard, MD, MPH; 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: wliaw@central.uh.edu
DOI: 10.3122/jabfm.2023.230328R2
Keywords: Communication, Jurisprudence, Primary Health Care, Qualitative Research, Social Determinants of Health, Social Factors, Social Problems, Trust
Dates: Submitted: 09-06-2023; Revised: 01-15-2024; 01-30-2024; Accepted: 02-19-2024
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BACKGROUND: Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization.
OBJECTIVE: The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics.
METHODS: A qualitative design utilizing a semi-structured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke’s framework was used to identify themes and subthemes.
RESULTS: Sixteen (n=16) participants were included in this study. Most respondents were female (81%) and white (56%). Four respondents were clinic staff, and four were MLP staff while eight were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact.
CONCLUSION: HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive.