Faculty, Staff and Student Publications

Publication Date

5-8-2023

Journal

Journal of the American Board of Family Medicine

DOI

10.3122/jabfm.2022.220349R1

PMID

37028914

Abstract

Purpose: To determine whether an immediate referral to a medical-legal partnership (MLP), compared with a 6-month waitlist control, improved mental health, health care use, and quality of life.

Methods: This trial randomly assigned individuals to an immediate referral or a wait-list control. The MLP involved a collaboration between the primary care clinic and a legal services organization. The primary outcome was stress (6 months) as measured by the Perceived Stress Scale (PSS). Secondary measures included the Center for Epidemiologic Studies Depression Scale; Generalized Anxiety Disorder scale (GAD-7); 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 threshold were used to identify noteworthy differences.

Results: Immediate referral was associated with lower PSS scores and higher GAD-7 scores. PROMIS scores were higher for the immediate referral group with respect to several subdomains. At 6 months, the immediate referral group demonstrated 21% fewer ED visits and 75.6% more hospital visits.

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.

Keywords

Humans, Mental Health, Quality of Life, Bayes Theorem, Primary Health Care, Delivery of Health Care, Clinical Trials, Family Medicine, Health-Harming Legal Needs, Mental Health, Primary Health Care, Quality of Life, Referral and Consultation, Social Determinants of Health

Comments

Trial registration: ClinicalTrials.gov Identifier: NCT03805126.

Published Open-Access

yes

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