Factors contributing to over-prescription of short-acting β2-agonists (SABA) inhalers in patients with asthma in Hong Kong: a qualitative study on primary care physicians’ perspective

To explore primary care physicians’ perceptions of factors contributing to over-prescription of short-acting beta2-agonist (SABA) inhalers in patients with asthma in a public primary healthcare setting in Hong Kong. TDF-informed qualitative interview study using individual semi-structured interviews and thematic analysis. 17 primary care physicians from the Department of Family Medicine and Primary Health Care in the New Territories West Cluster (NTWC) of Hospital Authority (HA) in Hong Kong were recruited and interviewed. Purposive sampling was adopted to ensure diversity of views. Inductively derived themes and subthemes describing perceived determinants of over-prescription of SABA inhalers, mapped deductively onto TDF domains. 4 major themes with 12 subthemes were identified: (1) knowledge of over-prescription of SABA inhalers, (2) balancing risks and benefits, (3) professional role and responsibility, and (4) environmental constraints. Physicians reported awareness of adverse outcomes associated with over-prescription of SABA inhalers but described knowledge gaps regarding usage thresholds; they perceived potential benefits of optimizing SABA inhaler prescription for benefits of patients and healthcare system yet feared of insufficient provision of reliever, patient confusion with new regimens, and strain on doctor–patient relationships. Participants saw themselves as gatekeepers responsible for guideline-concordant, evidence-based prescribing and patient education, but reported significant barriers from limited consultation time and lack of patient-friendly educational materials. Primary care physicians perceived that knowledge gaps, patient expectations, professional responsibilities, and environmental constraints were associated with over-prescription of SABA inhalers in public primary care setting in Hong Kong. These findings identify potential targets for future interventions.