From 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).
J Am Board Fam Med. 2024 Oct 25;37(4):637-649. doi: 10.3122/jabfm.2023.230328R2.
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.
The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics.
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.
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.
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.
某些与健康相关的风险因素需要法律干预。医疗法律伙伴关系（MLP）是诊所和律师之间的合作，旨在解决这些损害健康的法律需求（HHLN），并已被证明可以改善健康状况并减少利用。
本研究旨在探讨 MLP 在初级保健诊所实施的影响、障碍和促进因素。
采用半结构式访谈的定性设计，评估了 MLP 在临床医生、诊所和 MLP 工作人员以及诊所患者中的实施的感知影响、障碍和促进因素。使用 Open AI 软件（otter.ai）转录访谈，使用 NVivo 对数据进行编码。使用 Braun 和 Clarke 的框架来识别主题和子主题。
本研究纳入了 16 名（n=16）参与者。大多数受访者为女性（81%）和白人（56%）。4 名受访者为诊所工作人员，4 名为 MLP 工作人员，8 名为诊所患者。出现了几个主要主题，包括：患者经历了有害、普遍存在且复杂的法律问题；通过信任关系，MLP 能够改善健康状况并解决一些法律问题；不信任、沟通差距和人员配置不一致限制了 MLP 的影响；并且，MLP 确定了协调和沟通策略，以增强信任并扩大其影响。
HHLN 会对患者的身心健康产生重大负面影响。受访者认为，MLP 改善了健康状况并解决了一些需求。尽管取得了一定的成功，但临床和法律组织之间的整合仍然难以实现。
