Teleconsultation management of acute pharyngitis: Effect of physician training on appropriate antibiotic prescribing: A quasi-experimental study - Scorecard - MDSpire
Clinical Scorecard: Impact of Physician Training on Antibiotic Prescribing Practices in Teleconsultation for Acute Pharyngitis: A Quasi-Experimental Analysis
At a Glance
Category
Detail
Condition
Sore throat or suspected acute pharyngitis
Key Mechanisms
Guideline-based physician training was associated with improved documentation, remote examination, prescribing traceability, and in-person referral, but not reduced antibiotic prescribing
Target Population
Patients receiving teleconsultations for sore throat or suspected acute pharyngitis
Care Setting
French primary care telemedicine platform with community pharmacy–based rapid antigen testing
Key Highlights
The study evaluated 105 teleconsultations involving the same 50 physicians before and after training.
Documentation of medical history, allergies, and ongoing treatments improved significantly.
Requests for oropharyngeal photographs and photograph quality increased after training.
Assessment of swallowing difficulty and referral to in-person consultation increased.
McIsaac score documentation remained uncommon after training.
Antibiotic prescribing remained high and unchanged at 75.5% before training and 77.4% afterward.
Guideline-Based Recommendations
The study evaluated an intervention based on existing national guidance but did not establish new clinical guidelines.
Diagnosis
Structured assessment may incorporate the Centor or McIsaac score and, when indicated, rapid antigen detection testing for group A Streptococcus.
Direct physical examination is limited during teleconsultation.
Patient-provided oropharyngeal photographs may assist remote assessment but do not fully replace an in-person examination.
Referral to in-person care is important when severe features are suspected or diagnostic uncertainty prevents safe remote management.
Management
Existing guidance recommends restricting antibiotics to confirmed or highly probable bacterial infections.
In this service, antibiotic prescriptions were conditional on positive rapid antigen test results obtained in community pharmacies.
Actual test completion, antibiotic dispensing, consumption, and treatment adherence could not be determined.
The intervention improved documentation of penicillin allergy and recommended treatment duration but did not reduce prescribing.
Monitoring & Follow-up
Assess and document medical history, allergies, current treatments, clinical findings, severity signs, and swallowing difficulty.
Provide safety-netting advice and refer patients for in-person assessment when indicated.
Rapid antigen test results were rarely available to physicians during the teleconsultation.
The study did not assess recovery, persistent symptoms, repeat consultations, emergency visits, or hospitalization.
Risks
Diagnostic uncertainty may encourage empirical antibiotic prescribing during teleconsultations.
Cervical lymph node palpation and comprehensive oropharyngeal examination cannot be performed reliably remotely.
Infrequent McIsaac score documentation and variable photograph availability may limit standardized assessment.
A single educational session may not produce sustained changes in prescribing behavior without additional implementation strategies.
Patient & Prescribing Data
The study reported 105 teleconsultations for sore throat or suspected acute pharyngitis involving the same 50 physicians in both study phases. Antibiotic prescribing remained unchanged after training (75.5% vs 77.4%), as did RADT prescribing (81.1% vs 83.0%).
Amoxicillin accounted for 71% of antibiotic prescriptions, followed by azithromycin and cefpodoxime at 6% each. Actual antibiotic dispensing and consumption were not available.
Clinical Best Practices
Use structured history-taking and assess signs of severity during teleconsultation.
Apply and document the McIsaac score when appropriate.
Request interpretable oropharyngeal photographs when they may assist remote assessment.
Use in-person referral when physical examination or additional evaluation is required.
Combine education with improved rapid-testing access, audit and feedback, electronic decision support, or automated documentation prompts to support antimicrobial stewardship.
Related Resources & Content
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.
