Addressing challenges in care for patients with Clostridioides difficile infection
Clinicians face a range of challenges in diagnosing, treating and managing patients with C. difficile infection. We identified a number of opportunities and priorities for improving patient care, from the patient/clinician level up to the level of the healthcare system.
What is the issue?
C. difficile is a bacteria that is commonly found in the human digestive system. In healthy people, the bacteria does not cause any harm. However, the use of antibiotics can kill the gut bacteria that keeps C. difficile supressed, causing it to multiply to toxic levels. This can lead to a range of symptoms, such as diarrhoea, fever, swelling of the small intestine, sepsis and, in some cases, death.
Patients with C. difficile infections can face a number of challenges when getting a diagnosis, as well as undergoing treatment and management of the infection.
How did we help?
RAND Europe was commissioned by Ferring Pharmaceuticals to undertake an independent study that aimed to identify and characterise the challenges in the care pathway for patients with C. difficile infection and consider key areas for improvement in the care patients receive. The main focus was on learning from a range of countries, including the UK, Italy, France, Australia and Canada. The project included:
- A rapid evidence assessment to synthesise the knowledge base about the care pathway of patients with C. difficile infection, challenges and areas for improvement.
- Key informant interviews with clinicians and patient representatives to further explore the themes arising from the rapid evidence assessment and identify gaps in the literature.
- Consultative workshops with an expert panel.
- A survey with experts from the UK, France, Italy, Australia and Canada to identify actions that could be taken to improve patient care.
RAND Europe collaborated with a panel of clinical and patient representative experts in the delivery of this work.
What did we find?
We identified a range of challenges in diagnosing, treating and managing patients with C. difficile infection. Some of the key challenges we identified in the patient pathway were:
- The need to conduct multiple diagnostic tests to confirm a C. difficile infection which can slow diagnosis.
- Difficulties in distinguishing a new C. difficile infection from a recurring one, which has implications for treatment options.
- Challenges in knowing when a patient has been ‘cured’, as bacterial genes and toxins can remain in the body for long periods.
- The high cost of some C. difficile treatments (e.g. the antibiotic fidaxomicin), creating barriers to accessing treatments for patients.
- Barriers to accessing faecal microbiota transplantation, a treatment for recurrent C. difficile infection (e.g. workforce capacity and facility/resource availability).
What can be done?
There are a number of opportunities and priorities for improving the care of patients with C. difficile infection, from the patient/clinician level up to the level of the healthcare system. While the specific priorities varied across countries, some improvement actions were highlighted by at least 3 out of 5 countries of focus, which included:
- Develop new products for both preventing and treating recurrent C. difficile infections.
- Support greater multidisciplinary care for C. difficile patients.
- Update C. difficile diagnosis and treatment guidelines based on current data and evidence.
- Educate and support healthcare professionals in primary care and secondary care clinicians who are non-CDI experts on how to identify C. difficile symptoms and how to best manage patients.