Kamila Dymala, PharmD, RPh, MBA, BCMTM, PACS

Have you ever felt incompetent, despite the fact that those around you thought otherwise?

After a professional success or passing an exam, did you think that it was just luck that you succeeded?

Have you recently started a residency program and are worried that someone may find out that you don’t know something?

Have you recently been promoted to higher position, but feel that you don’t deserve it?

Have you ever felt that you won’t comment on some topics because you know too little about it and thought you will certainly embarrass yourself?

Imposter syndrome is a real challenge in pharmacy. The impostor phenomenon or imposter syndrome is described as a psychological experience of intellectual and professional fraudulence.

Individuals who experience these feelings may have the belief that others have inflated perceptions of their abilities and may be afraid of discovering their incompetence.

People who experience the impostor phenomenon believe that they are not worth their successes and doubt their knowledge, competence, and abilities.

The affected person feels out of place, unworthy of the successes, opportunities, and praise that befall them.

Imposter syndrome is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5); however, it is a real phenomenon, and it usually presents in certain situations—especially professional ones that we may perceive as stressful, challenging, or demanding.

Therefore, imposter syndrome is a phenomenon that affects self-confidence, significantly limiting the effectiveness of the professionals. This tendency has a negative impact on well-being and motivation, as well as reducing the effectiveness of action.

It represents excessively high expectations as to the standards we should achieve in knowledge and competence areas. The presence of the imposter syndrome is associated with:

Health care professionals may be affected by impostor phenomenon and the pharmacy profession is it not immune to that. Some self-report surveys presented that that those feelings were common among responding student pharmacists and faculty members.

A study shows that impostor phenomenon was common among undergraduates and pharmacy students. Moreover, the authors highlighted that the impostor phenomenon does not discriminate by education, age, gender, race/ethnicity, year in school, or academic major.

In another study, a survey on the prevalence of imposter syndrome among pharmacy residents indicated the residents have a significantly higher prevalence of imposter syndrome versus comparable groups.

A pilot study on the impostor phenomenon among medical students showed that it lead to professional burnout.

 Another study presented that perfectionism and the impostor are pertinent factors in the adjustment of health professional students, including medical, dental, nursing, and pharmacy students.

Those students experienced psychological distress, anxiety, and depression.

 The survey demonstrated positive associations between maladaptive perfectionism, impostor phenomenon, and suicidal ideation in medical students.

There are no direct studies to show how impostor phenomenon may affect practicing pharmacists. However, there are some publications about how negatively impostor phenomenon affects the mental health of medical students, residents, and physicians, as well as how medical culture can train for and/or exacerbate predispositions to develop impostor phenomenon.

The estimated percentage of people who may experience impostor phenomenon in the overall population is 70%.

 Previously, it was thought that women experience imposter syndrome more often.

Later research indicates that both men and women experience imposter syndrome.

 Environment or institutionalized discrimination, may play a major role in developing impostor feelings. The affected groups include racial or ethnic minorities, women in STEM fields, or even international students.

Health care professionals and students with imposter syndrome very often achieve great success. They are prone to perfectionism and set themselves with overly ambitious goals while fearing failure and enduring it much harder than other people; moreover, they do not get satisfaction from their successes.

They are also characterized by internal contradiction—on the one hand, they may need recognition and positive feedback from other people and on the other hand, they are not able to accept and fully believe in praise due to their negative self-image and low self-esteem.

Types of imposter syndrome are based on sets of destructive expectations adopted during the upbringing process. The first step in overcoming the imposter syndrome is to acknowledge what we are feeling and why it is happening.

Imposter syndrome was categorized it into 5 subgroups by Dr. Valerie Young, which include the 

Perfectionists, the Superman and Superwoman, the Natural Genius, the Soloists, and the Experts

Below are listed the destructive forms of expectations and beliefs with advice how to overcome them.

Perfectionists strive for flawlessness. Perfectionists set the bar very high for themselves and when they fail to achieve their goal 100% in every aspect, they begin to doubt themselves.

They are often convinced that other people will complete tasks less carefully than them, so they try to control everything around them strictly or do everything on their own.

Advice: If you recognize yourself or other people with perfectionism tendencies, begin to be more indulgent with the mistakes of yourself and others. Treat them as a natural part of learning and improving.

 are individuals who strive to be "the best" in all fields of action in life.

These types of people have ambitions to fulfill 100% in all roles in their lives, both professional and private. They force themselves to work beyond their strength to meet their exacting expectations. As a result, their relationships and health begin to suffer and they are at risk of burnout. Workaholics may become dependent on their environment to assess how they function in a given role.

Advice: It is important that people affected by this type of syndrome reflect on their expectations in the context of functioning in various roles and make a time balance sheet. What is real and what is not taking into account your rest and being in close relationships. It is also good for them to learn to accept constructive criticism not in person, but in relation to the task performed.

 is the belief that you may learn and do everything instantly, quickly and perfectly—sooner, faster, and better than others.

Brilliant people believe that it is important that the tasks are carried out, not only in the best possible and error-free manner, but also easily and quickly. If things don't come to them with the utmost ease and right away the first time, it is a failure for them.

Advice: Try to adopt a plan to improve your competences, recognizing that you will make many mistakes in the process. Make mistakes as a determinant on the way to your goal.

 may lead to imposter syndrome because individualistic systems urge people to pursue personal achievement, which creates competition between individuals and may lead to social anxiety.

Individualists are always carrying out tasks on their own. Collaboration or the necessary help from others is treated by the individualist as a sign of their weakness and lack of competence.

Advice: Start asking others for help and appreciate yourself for this type of behavior, treat it as acquiring new competences. People value and like other people more when they feel needed.

 want to know everything about a given topic.

Experts are mainly focused on getting all the knowledge on a given topic. In this situation, even a small lack of knowledge means failure and shame.

Experts have unrealistic expectations that they should know everything, they fear that they will be exposed. It is worth distinguishing here a healthy pursuit of development and learning new skills from an exaggerated tendency to constantly seek more knowledge, which is a form of procrastination.

Advice: Start becoming a mentor to others who have less knowledge and experience. Appreciate yourself for your competences—those you already have.

How we may overcome or reduce impostor syndrome?

It is worth realizing that our intelligence, skills, and competences are flexible abilities that we can broaden and deepen to a large extent. Failure and mistakes should not be a cause for shame and resignation, but can instead be seen as valuable guidance as to what can be improved and what we can work on to be even better.

It is natural that to achieve many of our ambitious goals, even those that initially seem unrealistic, we need to put forth significant effort, regardless of our level of intelligence or potential. The development of self-understanding, greater tolerance for one's own weaknesses, and the ability to sincerely appreciate ourselves for what we know can also play an important role.

If someone has entrusted us with a role or position, most likely they judged us as competent enough to be able to cope with this challenge. People who hired you or choose you for a position saw talent in you.

Do not doubt the intelligence of those who hired you, promoted you, or offered you a chance. They have made deliberate decisions based on your experience and potential—you really deserve to be there.

Other tips to overcome imposter syndrome include:

Choose someone you trust to tell them about your declining confidence and ask about additional support.

Take responsibility for your achievements and for your success.

When you achieve a goal or complete an important project, confirm out loud to yourself that it was achieved as a result of your talent and skill.

Examine everything you've gained and reflect on the hard work you've done to get where you are right now.

Practice listening to praise and wait for sincere compliments.

Listen carefully at what you say at loud and reduce negative self-talk.

Try mentoring—you have knowledge that you should share. Share it with someone who needs it. Not only will you notice how much you have to offer, but you will also discover your strengths during the process. Mentoring can reveal traits that you took for granted or mistakenly assumed were due to happiness. Besides, helping someone is a very empowering feeling.

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Articles

Imposter syndrome is a phenomenon that affects self-confidence, significantly limiting the effectiveness of professionals affected by it.

How to Overcome Imposter Syndrome in Pharmacy

Mineralocorticoid receptor antagonists (MRAs) also referred as aldosterone antagonists or anti-mineralocorticoids are class of drugs that block the effects of aldosterone.

Aldosterone synthesis, which occurs primarily in the adrenal gland, is modulated by multiple factors and may lead to oxidative stress, inflammation and organ fibrosis. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, blood vessels) tissues and increases blood pressure through induction of sodium reabsorption and potassium excretion. Mineralocorticoid receptor overactivation is a major driver of cardiovascular and kidney damage.

Aldosterone antagonists are important pharmacologic therapy in the neurohormonal blockade necessary in the treatment of hypertension and heart failure. Recent studies demonstrated that renal failure, proteinuria, and histologic renal lesions can be prevented by mineralocorticoid receptor antagonists.

Currently spironolactone, eplerenone, and finerenone are MRAs available for US patients. All drugs in class have similar mechanism of action as the potassium sparing diuretics the are competitively inhibiting mineralocorticoid receptors in the distal convoluted tubule to promote sodium and water excretion and potassium retention.

Table 1: Mineralocorticoid receptor antagonists comparison, structure, chemistry, distribution, and receptors affinity.

Spironolactone and eplerenone are steroidal MRAs but finerenone is a non-steroidal MRA. Spironolactone is non-selective MRA, however, eplerenone and finerenone are selective MRAs.

Spironolactone is a drug used as an add-on therapy in hypertension and New York Heart Association Class III-IV heart failure. It is used for a management of edema in cirrhotic adults not responsive to fluid and sodium restrictions. Additional indications include hyperaldosteronism and in nephrotic syndrome when treatment of the disease as well as fluid and sodium restriction with other diuretics is inadequate.

Spironolactone has antiandrogenic activity that leads to many of its off label uses, such as treatment of hirsutism, female pattern hair loss, and adult acne vulgaris.

Spironolactone is a drug used for its antiandrogenic effects in transgender female patients for reducing male-pattern hair growth.

The main contraindications to use the drug include hyperkalemia and Adison disease. The adverse effects (AEs) include gynecomastia, hyperkalemia,impotence, and menstrual irregularities.

Eplerenone is a compound similar to spironolactone; however, it is selectively binding to mineralocorticoid receptors relative to its binding to glucocorticoid, progesterone, and androgen receptors.

 Gynecomastia and hyperkalemia are less likely with eplerenone than spironolactone.

Finerenone is a dihydropyridine-based nonsteroidal mineralocorticoid receptor antagonist 

 to reduce the risk of kidney function decline, kidney failure, cardiovascular death, nonfatal heart attack, and hospitalization for heart failure in adults with chronic kidney disease (CKD) associated with type 2 diabetes mellitus (T2DM).

 By binding to the MR receptor, it reduces inflammation, fibrosis, and albuminuria in patients with diabetes and lowered the risk of first onset of kidney failure.

Finerenone blocks the mineralocorticoid receptor to reduce mortality and morbidity in patients with chronic severe congestive heart failure with an ejection fraction.

 It is distributed relatively equally between the heart and the kidney.

In comparison, spironolactone and eplerenone have higher concentrations in renal tissue than in cardiac tissue.

 Finerenone has no significant affinity or activity at androgen, progesterone, estrogen, and glucocorticoid receptors.

The drug binds selectively to the mineralocorticoid receptor and it is at least as potent as spironolactone with lower incidence of hyperkalemia and other AEs compared with both spironolactone and eplerenone.

 Finerenone was previously studied in the ARTS-DN randomized clinical trial to determine its efficacy on albuminuria in patients with diabetic nephropathy.

In another clinical trial, finerenone was associated with a reduction of a composite end point of all-cause mortality and heart failure outcomes in comparison to eplerenone.

The drug is currently investigated in study FINEARTS-HF to find its effect in heart failure with reduced ejection fraction and heart failure with preserved ejection fraction and in FIGARO-DKD to investigate the effect of medication on reducing cardiovascular mortality and morbidity with less advanced stages of CKD and T2DM.

Recent studies demonstrated that renal failure, proteinuria, and histologic renal lesions can be prevented by mineralocorticoid receptor antagonists.19Despite guideline-directed therapies, there remains a high unmet medical need in patients with CKD and T2DM, and there is increasing prevalence of patients with T2DM who are at risk for CKD.

The FIDELIO-DKD trial indicated that finerenone reduced the risk of cardiovascular and kidney failure outcomes in patients with and without a history of atherosclerotic cardiovascular disease. The results suggest that finerenone may represent an important treatment advance to reduce cardiovascular morbidity and mortality in patients with CKD and T2DM.

It may be recommended for reduction of the risk of sustained decline in glomerular filtration rate, end-stage kidney disease, cardiovascular death, heart attacks, and hospitalization due to heart failure in adults with CKD with T2DM. 

Finerenone is both a cardiovascular and kidney protective medication for individuals with T2DM and may be an option where SGLT2 inhibitors are not preferred.

Chrousos GP. Adrenocorticosteroids & Adrenocortical Antagonists. In: Katzung BG, Vanderah TW. eds. Basic & Clinical Pharmacology, 15e. McGraw Hill; 2021. https://accesspharmacy.mhmedical.com/content.aspx?bookid=2988&sectionid=250600694 Accessed March 09, 2022.

Sam R, Pearce D. Diuretic Agents. In: Katzung BG, Vanderah TW. eds. Basic & Clinical Pharmacology, 15e. McGraw Hill; 2021. https://accesspharmacy.mhmedical.com/content.aspx?bookid=2988&sectionid=250596112 Accessed March 9, 2022.

Bärfacker L, Kuhl A, Hillisch A, et al. Discovery of bay 94‐8862: A nonsteroidal antagonist of the mineralocorticoid receptor for the treatment of Cardiorenal diseases. 

https://chemistry-europe.onlinelibrary.wiley.com/doi/10.1002/cmdc.201200081. Published July 12, 2012. Accessed March 9, 2022.

Aldactone (spironolactone) [product monograph]. Kirkland, Quebec, Canada: Pfizer Canada Inc; July 2015.

Aldactone (spironolactone) [prescribing information]. New York, NY: Pfizer Inc; April 2018.

Millington K, Liu E, Chan YM: The Utility of Potassium Monitoring in Gender-Diverse Adolescents Taking Spironolactone. 

. 2019 Apr 4;3(5):1031-1038. doi: 10.1210/js.2019-00030.

Kim GK, Del Rosso JQ: Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris: Practical Considerations for the Clinician Based on Current Data and Clinical Experience. 

Rogerson FM, Yao Y, Smith BJ, Fuller PJ: Differences in the determinants of eplerenone, spironolactone and aldosterone binding to the mineralocorticoid receptor. 

Inspra (eplerenone) [prescribing information]. New York, NY: Pfizer Inc; May 2018.

Inspra (eplerenone) [product monograph]. Kirkland, Quebec, Canada: Pfizer Canada Inc; October 2016.

KERENDIA (finerenone) [prescribing information]. Whippany, NJ: Bayer HealthCare Pharmaceuticals, Inc.; July 2021.

Grune J, Beyhoff N, Smeir E, et al. Selective mineralocorticoid receptor cofactor modulation as molecular basis for finerenone’s antifibrotic activity. 

Pitt B, Kober L, Ponikowski P, et al. Safety and tolerability of the novel nonsteroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. 

Bakris GL, Agarwal R, Chan JC, et al. Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. 

Filippatos G. et al. Finerenone and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Type 2 Diabetes. 

. 2021;143:540–552. DOI: 10.1161/CIRCULATIONAHA.120.051898.

U.S. National Library of Medicine. Study to Evaluate the Efficacy (Effect on Disease) and Safety of Finerenone on Morbidity (Events Indicating Disease Worsening) & Mortality (Death Rate) in Participants With Heart Failure and Left Ventricular Ejection Fraction (Proportion of Blood Expelled Per Heart Stroke) Greater or Equal to 40% (FINEARTS-HF). https://clinicaltrials.gov/ct2/show/NCT04435626 Accessed March 9, 2022.

U.S National Library of Medicine Clinical Trials. Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and Diabetic Kidney Disease (FIDELIO-DKD) https://www.clinicaltrials.gov/ct2/show/NCT02540993 Accessed March 9, 2022.

Haller H, et al. Finerenone: a New Mineralocorticoid Receptor Antagonist Without Hyperkalemia: an Opportunity in Patients with CKD? 

. 2016;18: 41 DOI 10.1007/s11906-016-0649-2.

Bakris GL., et al. Design and Baseline Characteristics of the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease Trial. 

. 2019;50:333–344 DOI: 10.1159/000503713.

Recent studies demonstrated that renal failure, proteinuria, and histologic renal lesions can be prevented by mineralocorticoid receptor antagonists.

How Finerenone Compares to Other Mineralocorticoid Receptor Antagonists 

Food insecurity is defined as a lack of available resources for a sufficient quantity of affordable and nutritious food at the household level. According to the Feeding America organization, 42 million people (1 in 8), including 13 million children (1 in 6), in the United States had disruption of food intake or eating patterns because of lack of money and other resources in 2021.

This is slight improvement over what occurred in 2020, when the COVID-19 pandemic escalated the problem and 45 million people, including 13 million children, suffered because of food insecurity.

 As such, much work is needed to improve this situation in 2022.

Every health care professional should be concerned about food insecurity and must help to overcome the stigma and identify vulnerable populations. Pharmacists can help to reduce the prevalence of food insecurity and its negative health care outcomes by tailoring clinical care to each individual patient’s needs. As a profession, we are responsible for preventing negative pharmaceutical and health care outcomes driven by poor access to healthy foods, as well as to educate patients regarding where they may receive support.

However, food insecurity may affect everyone and it is not only related to access to food. Many individuals experiencing this problem have no access to fresh and high-quality nutritious meals. Everyone may experience food insecurity because of unemployment, change in family situation, change in health, disability of individual or family member, homelessness, and a lack of transportation, among other reasons. Food insecurity can affect individuals across demographics and regions.

Families affected by food insecurity and a lack of opportunities to meet their basic needs often are forced into inadvisable or even unavoidable choices, such as replacing products of a good quality with nutrient-poor products, not sending children to school, or simply restricting food intake. The effects of such choices are destructive to their health. The increase in food prices following the COVID-19 pandemic made healthy options less accessible, especially for the families of the lowest income.

Food insecurity is a complex problem and a key social determinant of health because it affects outcomes. People with a limited ability to have a balanced diet have a higher risk of developing chronic diseases.

Food-insecure senior patients are 50% more likely to develop diabetes as well as obesity and diet-related health conditions.

They are 60% more likely to have congestive heart disease or experience a heart attack and 14% more likely to have hypertension.

Food insecure patients also have a higher risk of other cardiovascular diseases, including coronary heart disease and stroke. In addition, they are twice as likely to have asthma and chronic obstructive pulmonary disease.

 It also increases negative outcomes for pregnant patients. 

Hepatitis, cancer, arthritis, and anemia are very common in this population. Food insecurity also affects psychological health and may lead to anxiety and depression.

In children, it may lead to deficits in socio-emotional, cognitive, and motor functioning. Older patients have a diminished capacity to maintain independence while aging if they were food insecure in the past.

According to the study Hunger in America, 66% of households had to choose between food and medical care in 2014.

This can lead to medications non-adherence, poor disease self-management, mask underlying health conditions, cause misdiagnosis, and subsequently lead to more and longer hospitalizations with increased health costs.

For pharmacists and technicians screening for food insecure individuals, it is important to talk openly and tactfully while eliminating unconscious bias. Patients are asked to answer to the following statements with the answers “often true, sometimes true, or never true.”

“Within the past 12 months, we worried whether our food would run out before we had money to buy more.”

“Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.”

If the response to either statement is often true or “sometimes true, the individuals are identified as food insecure.

Patients should be consulted how food insecurity may lead to undesirable health outcomes and how to prevent medications adverse reactions.

If patients have diabetes and are using insulins, taking sulfonylurea or meglitinides, they should be informed about the risks, signs, and symptoms of hypoglycemia, as well as how to act in case of emergency. If using insulin, patients must know how to adjust doses.

If patients are taking meglitinides, it is recommended to skip the dose when they skip a meal. Metformin should be taken with meals because it may reduce gastrointestinal adverse effects (AEs), especially when starting therapy. Because of its unique mechanism of action, acarbose should be taken with food or swallowed whole with a little liquid immediately before food.

Some medications, including allopurinol and bromocriptine, must be taken after meals to reduce AEs such as nausea and vomiting. Aspirin, non-steroidal anti-inflammatory drugs, and steroids should be taken with meals to reduce the risk of stomach irritation or ulcer formation.

Food is needed to ensure the medicine is absorbed into the bloodstream in the case of taking ritonavir, griseofulvin, and itraconazole (capsules only). 

Carvedilol should be taken with food to slow its rate of absorption and to reduce the risk of orthostatic hypotension.

These are just a few examples. There are more medications that should be taken before or with a meal because of their pharmacokinetics, absorption requirements, or risk of AEs. This is why during patient counseling, it is not sufficient to simply tell patients to take medication with food or after meals only. We need to know whether patients are food insecure.

It is important to encourage your food-insecure patients to look for help and to implement healthy diet habits. Patients should avoid diet monotony and limit their intake of unhealthy food as much as possible. It is important to explain to patients how to read nutrition fact labels of products as well as to encourage them to introduce healthier alternatives.

Chronic stress and anxiety of food insecurity can and should be solved. It is very important to refer patients to places where they may receive help. The following links can help them find assistance in their communities.

feedingamerica.org/find-your-local-foodbank

feedingamerica.org/our-work/hunger-relief-programs/mobile-food-pantry-program

Food and Nutrition Service US Department of Agriculture: 

Special Supplemental Nutrition Program for Women, Infants, and Children US Department of Agriculture: 

Emergency Food Assistance Program US Department of Agriculture: 

fns.usda.gov/tefap/emergency-food-assistance-program

Supplemental Nutrition Assistance Program US Department of Agriculture: 

fns.usda.gov/snap/supplemental-nutrition-assistance-program

National School Lunch Program US Department of Agriculture: 

School Breakfast Program US Department of Agriculture: 

fns.usda.gov/sbp/school-breakfast-program

threesquare.org/learn/programs/childhood-nutrition/kids-cafe

feedingamerica.org/our-work/hunger-relief-programs/backpack-program

feedingamerica.org/our-work/hunger-relief-programs/summer-food-service-program

feedingamerica.org/our-work/disaster-food-assistance

Seniors Farmers' Market Nutrition Program US Department of Agriculture: 

fns.usda.gov/sfmnp/senior-farmers-market-nutrition-program

Commodity Supplemental Food Program US Department of Agriculture: 

fns.usda.gov/csfp/commodity-supplemental-food-program

The National Produce Prescription Collaborative: 

As pharmacy professionals, we are responsible for advocating and educating our peers how to address food insecurity and its root causes to improve our patient’s health outcomes as well as to prevent adverse drug reactions related to food insecurity.

Feeding America. The Impact of the Coronavirus on Food Insecurity in 2020 & 2021. March, 2021. Accessed December 10, 2021. https://www.feedingamerica.org/sites/default/files/2021-03/National%20Projections%20Brief_3.9.2021_0.pdf

Zaliak JP, Gundersen C. 2014. The health consequences of senior hunger in the United States: Evidence from the 1999-2010 NHANES. August 16, 2017. Accessed December 10, 2021. https://www.feedingamerica.org/sites/default/files/research/senior-hunger-research/senior-health-consequences-2014.pdf

Feeding America. Hunger in America 2014 National Report. August 2014. Accessed December 10, 2021. http://help.feedingamerica.org/HungerInAmerica/hunger-in-america-2014-full-report.pdf

Feeding America. Addressing food insecurity in health care settings. Hunger and Health. October 7, 2019. Accessed December 10, 2021. https://hungerandhealth.feedingamerica.org/explore-our-work/community-health-care-partnerships/addressing-food-insecurity-in-health-care-settings/

Feeding America. Causes and consequences of food insecurity. Hunger and Health. February 20, 2020. Accessed December 10, 2021. https://hungerandhealth.feedingamerica.org/understand-food-insecurity/hunger-health-101/

Alisha Coleman-Jensen, Matthew P. Rabbitt, Christian A. Gregory, and Anita Singh. 2021. 

Household Food Security in the United States in 2020

, ERR-298, U.S. Department of Agriculture, Economic Research Service.

Cooper E, et al. An In-Clinic Food Pharmacy Addresses Very Low Food Security. 

Gundersen C, Ziliak JP. Food Insecurity and Health Outcomes. 

 2015;34(11):1830-9. doi: 10.1377/hlthaff.2015.0645. PMID: 26526240.

Healthy People 2020. Food Insecurity. Accessed December 10, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/food-insecurity

Laraia BA, Leak TM, Tester JM, Leung CW. Biobehavioral Factors That Shape Nutrition in Low-Income Populations. 

. 2017;52(2)(suppl 2): S118-S126. doi.org/10.1016/j.amepre.2016.08.003

Pharmacists can help to reduce the prevalence of food insecurity and its negative health care outcomes by tailoring clinical care to each individual patient’s needs. 