Engaging primary care providers and patient partners in co-developing a provincial pathway in the management of recurrent Clostridioides difficile infection - Provincial FMT algorithm development

Project Partners

University of Alberta Hospital

Alberta Health Services (AHS)

Primary care physicians

Gastroenterologists

Infectious disease specialists

Nurse navigator

PLP (likely Physician Learning Program, inferred from context)

Background

Recurrent Clostridioides difficile infection (rCDI) imposes significant healthcare and patient burdens, with outcomes ranging from mild diarrhea to severe, life-threatening complications. Often triggered by prior antibiotic use, CDI is especially concerning in acute care settings. Though fecal microbiota transplantation (FMT) has shown over 80% effectiveness, it remains investigational in Canada, lacks standardization, and is not widely accessible. Low awareness among primary care providers contributes to inconsistent treatment approaches and regional disparities in care, particularly in Edmonton and across Alberta.

Aims/Objectives

Establish a standardized provincial clinical pathway for rCDI and FMT

Identify knowledge gaps among referring physicians

Understand patient needs and preferences in the care process

Apply human-centered design (HCD) to develop tools and pathway components

Conduct user testing and revise tools based on stakeholder feedback

Support knowledge transfer to enhance pathway adoption and effectiveness

Findings/Summary

Between April 1, 2024, and March 31, 2025, the CDI and FMT Referral Pathway Project achieved several major milestones. A stool bank was established at the University of Alberta Hospital, and a user-friendly clinical pathway algorithm was developed and refined with feedback from diverse clinical stakeholders. Engagement sessions with primary care physicians, specialists, and a nurse navigator ensured the pathway reflected current best practices. Usability testing confirmed the pathway’s clarity and practical application. Alberta Health Services contributed feedback to inform final revisions. Additionally, patient-facing resources were created to support education, informed decision-making, and treatment adherence. The project has officially concluded and been handed off to the provincial pathway unit for further implementation and integration.

Conclusions/Outcomes/Impact/Implications

This project has created a practical, evidence-informed clinical pathway for rCDI management that aligns with current practice needs and patient priorities. The human-centered design approach ensured the pathway is both user-friendly and responsive to stakeholder input. With the project transitioned to the provincial pathway unit, the foundation is in place to scale its implementation, improve referral consistency, and reduce treatment disparities across Alberta.