Leadership Program Spurs Transformation in Lupus Care

By Susan Gallagher

Managing the broad range of symptoms of lupus, a chronic autoimmune disease that can cause extreme fatigue, skin rashes, fever, and joint pain, left Uniqua Harris, of Durham, ready to “bash lupus ‘til you couldn’t bash it anymore.” A year ago, it was hard for her to stay positive, and she said she often doubted herself.  

“Now, I literally don’t put ‘can’t’ in my vocabulary,” said Harris, 25, who has, following a diagnosis of lupus at age 9, benefitted from a new approach to lupus care that gives patients support with symptoms and stress.  

Launched as a Duke Advanced Practice Provider Leadership Institute (APPLI) project, the lupus care model involves a rheumatologist, physician assistant, nurse practitioner, clinical social worker, psychologist, registered dietitian, and physical therapist. Together, they address patients’ medical and psychological needs to help improve their health.  

Keisha-Gaye O’Garo, PsyD, an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine, and Karen McCain, a psychiatric nurse practitioner, lead the project that expands services offered to lupus patients at the Duke Young Adult Rheumatology Clinic. 

The health care providers wanted to focus their APPLI project on a chronic medical illness with a significant impact on Black patients. Anyone can develop lupus, but women account for 90% of cases and it’s most common among Black and Latina women, ages 15-44.   

“We decided to target lupus because it has extremely high mortality rates for Black females, in some cases at a very young age,” said O’Garo, a clinical psychologist at the Duke Pain Clinic. “And we need to start talking to one another about how to address some of the barriers they face and ensure we’re providing equitable health care.”   

The approach has been a significant change for the clinicians on the team and led to health improvements for most of the 10 women who have participated so far, including Harris.  

“I feel like I’m in a better headspace,” she said. “I’ve always been a driven person but having more medical providers on board has made me tap more into who I am and helped me embrace my illness.”   

Her determination has paid off. In May, she earned her master’s degree in accounting from North Carolina State University, and she will launch her accounting career at Deloitte in Charlotte, North Carolina, this fall.  

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Main Photo: From left, Karen McCain, psychiatric nurse practitioner; Keisha O’Garo, PsyD, clinical psychologist at the Duke Pain Clinic; Rebecca Sadun, MD, PhD, director of the Duke Young Adult Rheumatology Clinic, and Anh Tran, PhD, director of the Duke Advanced Practice Provider Leadership Institute, fostered a team approach to lupus care at Duke Health. (Photo by Les Todd)