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A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators
Winston Liaw1, Christine Bakos-Block1, Thomas F Northrup1
1From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL); School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX (CBB); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX (TFN); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX (ALS); Department of Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX (AH); Department of Counseling, Wake Forest University, Winston-Salem, NC (LF); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (PO); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BMR); University of Houston Tilman J. Fertitta Family College of Medicine (SJ); Division of Kinesiology and Health; University of Wyoming College of Health Sciences; Laramie, WY Dobbins: (LG); Humana, Inc., Louisville, KY (JD); Department of Medicine and Office of Community Engagement and Health Equity; Baylor College of Medicine; Houston, TX (LW); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX (TM).
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 using a semistructured 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 women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 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.
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