Impact of Physician Training on Antibiotic Prescribing Practices in Teleconsultation

Overview

This retrospective quasi-experimental study evaluated the effects of guideline-based physician training on clinical assessment, documentation, remote examination, antibiotic prescribing, and referral practices during teleconsultations for sore throat or suspected acute pharyngitis. Training improved several measures of teleconsultation quality but did not reduce antibiotic prescribing.

Background

Acute pharyngitis is a frequent reason for teleconsultation. Management typically relies on structured clinical assessment, clinical scores such as Centor or McIsaac, and rapid antigen detection testing when indicated. Telemedicine limits direct physical examination and immediate access to testing, which may increase diagnostic uncertainty and encourage empirical antibiotic prescribing. Existing guidance recommends restricting antibiotics to confirmed or highly probable bacterial infections.

Data Highlights

• Physicians participating in both phases: 50

• Teleconsultations analyzed: 105

• Medical history documented: 13.2% before training vs 60.8% afterward

• Allergies documented: 18.9% vs 74.4%

• Ongoing treatments documented: 5.7% vs 67.3%

• Oropharyngeal photographs requested: 56.6% vs 79.2%

• Swallowing difficulty assessed: 30.2% vs 63.3%

• In-person referrals: 2.0% vs 35.8%

• Antibiotic prescribing: 75.5% vs 77.4%

Key Findings

• Guideline-based training significantly improved documentation of medical history, allergies, and current treatments.

• Requests for oropharyngeal photographs increased, and adequate lighting and image clarity improved.

• Assessment of swallowing difficulty and referral to in-person care increased significantly.

• McIsaac score documentation remained uncommon, increasing from 1.9% to 13.2% without reaching statistical significance.

• RADT prescribing remained frequent and unchanged, and test results were rarely available during teleconsultations.

• Antibiotic prescribing remained high and unchanged after training.

• Documentation of penicillin allergy and recommended treatment duration improved.

• Antibiotic prescriptions were conditional on positive RADT results obtained in community pharmacies, but actual testing, dispensing, consumption, and treatment adherence could not be determined.

Clinical Implications

A single educational session improved the structure and standardization of teleconsultations but did not change the overall antibiotic-prescribing rate. The findings suggest that education alone may be insufficient to modify prescribing behavior. Better access to rapid testing, audit and feedback, electronic decision support, automated documentation prompts, and other measures integrated into clinical workflows may be needed to strengthen antimicrobial stewardship.

Conclusion

Guideline-based training was associated with improved clinical documentation, remote examination, prescribing traceability, and referral to in-person care during teleconsultations for sore throat or suspected acute pharyngitis. Antibiotic prescribing remained high and unchanged, highlighting persistent stewardship challenges and the potential need for structural adaptations beyond physician education.

Related Resources & Content

1. Teleconsultation Management of Acute Pharyngitis: Effect of Physician Training on Appropriate Antibiotic Prescribing: A Quasi-Experimental Study — Nafzaoui M, Cauterman M, Ouchanin F, et al. International Journal of Infectious Diseases. 2026;171:109028. doi:10.1016/j.ijid.2026.109028.

2. Quality of Care for Acute Respiratory Infections During Direct-to-Consumer Telemedicine Visits for Adults — Shi Z, Mehrotra A, Gidengil CA, Poon SJ, Uscher-Pines L, Ray KN. Health Affairs. 2018;37:2014–2023.

3. Clinical Score and Rapid Antigen Detection Test to Guide Antibiotic Use for Sore Throats: Randomised Controlled Trial of PRISM — Little P, Hobbs FDR, Moore M, et al. BMJ. 2013;347:f5806.

4. Choix et durées d’antibiothérapies: Angine aiguë de l’adulte — Haute Autorité de Santé. Accessed March 19, 2026.