Teleconsultation management of acute pharyngitis: Effect of physician training on appropriate antibiotic prescribing:...

Teleconsultation is increasingly used in primary care for acute respiratory infections, including sore throat. However, limited physical examination and restricted access to rapid diagnostic testing may affect antibiotic prescribing in remote care. Therefore, we aimed to evaluate the impact of a guideline-based educational intervention on physicians' management of acute pharyngitis during teleconsultations, with a particular focus on the quality of clinical assessment and documentation, antibiotic prescribing METHODS: We conducted a retrospective study of teleconsultations for sore throat or suspected acute pharyngitis on a French primary care telemedicine platform. A physician training program based on national guidelines was implemented. Clinical practices before and after training were compared, focusing on documentation quality, remote examination, antibiotic prescribing, and referral to in-person care.

A total of 105 teleconsultations were analyzed (53 before and 52 after training). Following the educational intervention, documentation of medical history increased from 13.2% to 60.8% (P < 0.001), allergies from 18.9% to 74.4% (P < 0.001), and ongoing treatments from 5.7% to 67.3% (P < 0.001). Requests for oropharyngeal photographs increased from 56.6% to 79.2% (P = 0.021), while photograph quality also improved, with adequate lighting rising from 65.1% to 86.4% (P = 0.037) and clear images from 62.8% to 84.1% (P = 0.044). Assessment of swallowing difficulty increased from 30.2% to 63.3% (P = 0.001), and referral to in-person consultation rose from 2.0% to 35.8% (P < 0.001). Documentation of the McIsaac score remained uncommon, increasing from 1.9% to 13.2% (P = 0.060). In contrast, antibiotic prescribing remained high and unchanged (75.5% vs 77.4%, P = 1.00), as did rapid antigen detection test prescribing (81.1% vs 83.0%, P = 1.00).

Training improved teleconsultation practices but did not reduce antibiotic prescribing, highlighting persistent stewardship challenges in telemedicine.