Objective:

To evaluate how a guideline-based educational intervention affected physicians’ clinical assessment, documentation, antibiotic prescribing, and referral practices during teleconsultations for sore throat or suspected acute pharyngitis.

Approach:

• Study Design: This retrospective observational quasi-experimental study compared physicians’ practices before and after a targeted educational intervention on the MédecinDirect primary care telemedicine platform in France.
• Participants and Consultations: The same 50 physicians participated in both phases, allowing within-physician comparison. The study reported analyzing 105 teleconsultations conducted during separate pretraining and post-training periods.
• Intervention: Physicians attended a standardized 1-hour interactive webinar covering national guidelines, telemedicine-oriented clinical scenarios, structured history-taking, severity signs, McIsaac scoring, rapid antigen detection testing (RADT), antibiotic stewardship, remote examination, and criteria for in-person referral.
• Data Collection: Extracted measures included clinical documentation, severity assessment, requests for oropharyngeal photographs, photograph quality, antibiotic and RADT prescribing, and referral to in-person care.
• Statistical Analysis: Analyses were performed using R. Categorical variables were reported as counts and percentages, and continuous variables as means with standard deviations or medians with interquartile ranges. Appropriate categorical and continuous-variable tests were used, with *P* < .05 considered statistically significant.

Key Findings:

• Documentation improved after training for medical history (13.2% to 60.8%), allergies (18.9% to 74.4%), and ongoing treatments (5.7% to 67.3%; all *P* < .001).
• Requests for oropharyngeal photographs increased from 56.6% to 79.2%, while adequate lighting and image clarity also improved.
• Assessment of swallowing difficulty increased from 30.2% to 63.3% (*P* = .001).
• Referral to in-person consultation increased from 2.0% to 35.8% (*P* < .001).
• McIsaac score documentation remained uncommon, increasing from 1.9% to 13.2% without reaching statistical significance.
• Antibiotic prescribing remained high and unchanged after training (75.5% vs 77.4%), as did RADT prescribing (81.1% vs 83.0%).
• Antibiotic prescriptions were conditional on positive RADT results obtained in community pharmacies, but actual testing adherence, dispensing, and antibiotic consumption could not be determined.
• Prescribing documentation improved for penicillin allergy and recommended treatment duration.

Interpretation:

The intervention was associated with better clinical documentation, remote examination practices, prescribing traceability, and recognition of cases requiring in-person assessment. However, it did not reduce antibiotic prescribing. The findings suggest that a single educational session improved the structure and standardization of teleconsultations more than the final prescribing decision, and that additional workflow-based measures may be needed to strengthen antimicrobial stewardship.

Limitations:

• The retrospective design relied on routinely collected documentation, which was incomplete or inconsistent for some variables.
• No control group was included, preventing firm causal attribution of observed changes to the intervention.
• No formal sample-size calculation was performed, and the study was exploratory.
• The pretraining and post-training periods were not identical, creating potential temporal bias.
• Patient outcomes, including clinical recovery, persistent symptoms, repeat consultations, emergency visits, and hospitalization, were not assessed.
• Actual RADT completion, antibiotic dispensing, and treatment adherence could not be evaluated.
• Increased in-person referrals may have changed the case mix remaining in teleconsultation after training.
• Individual engagement with the webinar, long-term knowledge retention, and adherence to institutional protocols were not objectively monitored.

Conclusion:

Guideline-based physician training was associated with improved clinical documentation, remote examination, prescribing quality, and referral to in-person care during teleconsultations for sore throat or suspected acute pharyngitis. Antibiotic prescribing remained high and unchanged, indicating that education alone may be insufficient to alter prescribing behavior. Better access to rapid testing, electronic decision support, audit and feedback, and other structural adaptations may be required to improve antimicrobial stewardship in telemedicine.