JMIR Publications

ABSTRACT

Background:

Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated infectious diarrhea, but diagnostic confusion persists due to variable laboratory testing algorithms. Recurrent CDI (rCDI) occurs when infection returns after initial treatment and poses a significant challenge due to limited therapeutic options. While healthcare providers are comfortable with vancomycin being the first line therapy for CDI, most are not familiar with fecal microbiota transplantation (FMT) as a guideline recommended treatment for rCDI. As such, practitioners frequently face difficulties in managing CDI and rCDI.

Objective:

This study aims to support the standardization of care and improve patient treatment experiences in Alberta by identifying barriers and facilitators encountered by primary care providers (PCP) in managing CDI and rCDI, using these findings to co-develop a provincial rCDI clinical pathway.

Methods:

This study investigated the co-creation process of a provincial clinical pathway for rCDI between the study team and three end users, PCPs, utilizing an iterative user-centred design through a series of one-on-one interview sessions. A draft provincial rCDI clinical pathway was developed by the study team and refined iteratively following two 60–90-minute virtual interviews and usability testing, focusing on challenges, and feasibility of integrating the pathway into clinical practice and workflows.

Results:

The co-developed provincial rCDI clinical pathway, and accompanying user guide were well received for their clarity, readability, and practical guidance. Based on participant feedback, revisions improved C. difficile test result interpretation, enhanced navigation, hyperlink visibility, and provided detailed instructions for alternative clinical scenarios.

Conclusions:

Our study demonstrated the feasibility and value of co-creating a provincial clinical pathway with physician partners for managing CDI and rCDI. The resulting tool was clear, practical, and aligned with clinical workflows. Some perspectives remain underrepresented, highlighting the need for ongoing iterative refinement to improve this pathway. Future research should evaluate the pathway’s impact on physician practice, patient care, and clinical outcomes using both quantitative and qualitative methods.