{"doi":"10.1111/jgs.19381","title":"Clinician Perspectives on Increased Gabapentinoid Prescribing in Nursing Homes","abstract":"Gabapentinoid use in nursing homes (NHs) is rapidly increasing, though the reasons for this evolving trend remain opaque [1, 2]. To bridge this knowledge gap, we conducted two iterative surveys of NH prescribing clinicians. The first survey focused on why gabapentinoids are prescribed in NHs; the second assessed the magnitude of prescribing for each identified indication. Both explored provider perspectives on factors influencing gabapentinoid increases and barriers to deprescribing [3]. These surveys revealed that gabapentinoids are increasingly applied off-label not only for all neuropathic pain but also for every form of pain. Most clinicians also perceive gabapentinoids as helpful in moderating behavioral and psychological symptoms, and neuropsychiatric treatment goals influence prescribing. Furthermore, clinicians directly linked gabapentinoid gains with opioid and psychotropic reduction policies as gabapentinoids are viewed as reasonable but unmonitored alternatives to these medications [3]. In addition to these structured responses, results also included 111 clinician free-text responses, offering granular insights into gabapentinoid prescribing practices unobtainable by descriptive statistics alone. This qualitative analysis of that free-text response data deepens our understanding of NH prescribers' increasing reliance on gabapentinoids. In October 2023 and May 2024, we used SurveyMonkey to anonymously survey NH clinicians about their gabapentinoid prescribing practices, exploring the indications for use and the factors driving prevalence gains. The first survey inventoried why gabapentinoids are prescribed in NHs, the second iteratively quantified the relative scope of such prescribing [3]. A multidisciplinary team developed the surveys, grounding them in existing literature and emerging data [4-6]. We employed convenience sampling through crowdsourcing, engaging with NH clinician networks to reach a diverse range of clinicians. Participants had four opportunities to provide open-ended insights to enrich responses. Both surveys included the open-ended question “Is there anything else you feel is important for us to know about your use of gabapentin or the challenges of managing behavioral symptoms related to dementia?” Two additional questions also allowed free responses, “I would use gabapentin less if…,” and “I use pregabalin (Lyrica) less often than gabapentin because….” From these observations, themes were identified through an iterative process of immersive crystallization using codes that emerged during data collection and early immersion/crystallization, with differences reconciled by team consensus [7]. Both survey instruments and additional methodological detail are available as online supplements. One-hundred-eighty-seven NH clinicians participated in the surveys of which 78 provided 111 free responses. All major geographic regions in the United States were represented by free respondents. About 30% were from rural regions, two-thirds were from middle-income areas, and a quarter was from high-income areas. Clinicians who volunteered free responses were more likely to be physicians and had greater NH experience than those who gave no free responses; otherwise no important differences were detected. The characteristics of the free responders are summarized in Table 1 and reasonably approximate the NH clinician population [8]. Five themes emerged regarding increased gabapentinoid use in NHs where respondents generally agreed. Table 2 outlines exemplar quotes. Theme 1: Polarized beliefs about safety and efficacy. Clinicians displayed divergent opinions about gabapentinoids. Some viewed them as low-risk and beneficial for various off-label uses; others described significant potential for harm and minimal benefits. Notably, there were no meaningful differences in characteristics between these clinician subgroups. Theme 2: Influence of opioid and psychotropic reduction policies. Gabapentinoids are appealing as les","journal":"Journal of the American Geriatrics Society","year":2025,"id":550133,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9548,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1194816,"name":"J. William Kerns","orcid":"0009-0003-2056-273X","position":1,"is_corresponding":false},{"id":1107457,"name":"Danya M. Qato","orcid":"0000-0002-6355-1526","position":2,"is_corresponding":false},{"id":1195107,"name":"Katherine Winter","orcid":null,"position":3,"is_corresponding":false},{"id":929042,"name":"Nicole Brandt","orcid":"0000-0003-2766-6120","position":4,"is_corresponding":false},{"id":1107899,"name":"Linda Wastila","orcid":null,"position":5,"is_corresponding":false},{"id":1194819,"name":"Christopher Winter","orcid":"0009-0008-3255-7352","position":6,"is_corresponding":false},{"id":1195109,"name":"Yu‐Hua Fu","orcid":null,"position":7,"is_corresponding":false},{"id":1194820,"name":"Eposi Elonge","orcid":"0009-0008-5474-6808","position":8,"is_corresponding":false},{"id":384727,"name":"Alex H. Krist","orcid":"0000-0003-4060-9155","position":9,"is_corresponding":false},{"id":543205,"name":"Sarah Reves","orcid":null,"position":10,"is_corresponding":false},{"id":542572,"name":"Rebecca Etz","orcid":"0000-0001-6906-7738","position":11,"is_corresponding":false},{"id":1194815,"name":"Jonathan D. Winter","orcid":"0000-0001-8650-5066","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-19T02:54:12.321988Z","pmid":"39907355","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}