At Merck, we believe that people must be at the center of their healthcare.

For more than 100 years, Merck has provided unbiased and independently reviewed health information to the public and to healthcare professionals, directly and through independent enterprises as a not-for-profit service.

KEY DEFINITIONS

Healthcare Disparities—Differences or gaps in care experienced by one population compared with another population, due in part to:

• Lack of access to care
• Provider biases and other issues
• Poor provider communication
• Poor health literacy

Health Literacy (U.S.)—The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

The Merck Manuals

In 1899, we published the first edition of The Merck Manual, a 192-page resource book designed to aid physicians and pharmacists. By the 1980s, The Merck Manual was the world’s best-selling medical text and had been translated into 17 languages. The 19th edition, published in July 2011, now comes with a free app for pocket mobile devices. This updated edition reflects progress in both medicine and technology as it keeps pace with the many electronic platforms used to deliver information to healthcare professionals.

In 1997, we created The Merck Manual—Home Edition to provide the benefits of the Manual for the general public. In its third edition, renamed The Merck Manual—Home Health Handbook, more than 3 million copies have been sold and translated into 12 languages. As part of our commitment to provide medical information for those who want it, we offer the content of these Merck manuals on the Web free of charge. Registration is not required, and use is unlimited. The Merck Manual on the Web is updated to ensure that its information is as current as possible. In addition, during 2011, we donated 30,000 copies of The Merck Manual to nongovernmental organizations (NGOs) for distribution to physicians, nurses and community health workers throughout developing countries.

We also publish other books, such as The Merck Index for chemists and biologists (since 1889); The Merck Veterinary Manual (since 1955), for veterinarians; The Merck Manual of Health & Aging, which provides professionals and consumers with useful health care information for older adults; The Merck/Merial Manual for Pet Health, which covers the full spectrum of today's pets—from dogs, cats and horses to birds, reptiles, fish and other exotic pets; and, most recently, The Merck Manual of Patient Symptoms, a guide for medical students, residents, nurse practitioners and physician assistants. Learn more.

MerckEngage

MerckEngage.com, a free online tool available in the U.S., offers resources that reinforce healthy lifestyle choices, provide disease-specific education, support adherence to therapy, and help U.S. healthcare consumers have more productive interactions with their healthcare professionals. The site also provides support and encouragement for caregivers, who are often engaged in the day-to-day care and treatment decisions of family members and friends.

The site is a component of the MerckEngage Health Partnership Program, which provides healthcare professionals with health support materials and tools for their patients who have been prescribed certain Merck medications. The program is designed to support the healthcare professional/healthcare consumer relationship by providing tools and tips, online, in print and through a call center, for healthier living between office visits. The MerckEngage Health Partnership Program makes available health coaches who work one-on-one with eligible members to help them achieve their own health goals.

The Adherence Estimator

Patients often fail to reach clinical goals because they don’t take medications when they are supposed to. At Merck, we remain committed to identifying the reasons why patients are not always compliant and support the development of improved evidence-based interventions that can lead to better health outcomes.

The Adherence Estimator, an evidence-based, patient-centered tool designed to help identify patients who may be at risk of medication nonadherence and provide the specific reason(s) they may be at risk of discontinuing therapy. The Adherence Estimator was designed to be administered shortly after the initiation of new therapy and to be completed for each new medication prescribed. It asks questions about the three key areas that affect compliance: patients’ concerns about prescription medication, their perception of the need for prescription medication, and their perceived financial burden due to the cost of prescription medication. After respondents answer the questions, the tool provides easy-to-understand, personalized information that may address patient’s concerns about taking medication.

Script Your Future

Merck is is a founding member of Script Your Future, a national campaign led by the National Consumers League (NCL) to raise awareness about the health consequences of not taking medications as directed.

SPARSH

SPARSH is a patient-support initiative for diabetes patients who are taking certain Merck medicines. The program was created in India in partnership with physicians who voiced the need for more-robust patient support. Enrolled patients receive counseling on diabetes care, complications of diabetes, and diet and exercise through telephone calls.

Healthcare Disparities and Health Literacy—U.S. Efforts

Many communities around the world, especially underserved and marginalized populations, often face multiple barriers to accessing preventive healthcare services and specialty care for chronic conditions, which can contribute to healthcare disparities. Within the United States, certain populations of healthcare consumers (HCC) are in greater need of health services—in part due to the growing diversity of the U.S. and to the disproportionate representation of certain diverse audiences in chronic illnesses, such as diabetes or hypertension. In addition, the more linguistically diverse this country becomes, the more critical the need for communication that clearly and accurately promotes HCC safety and healthcare quality. Globally, many communities are still excluded from quality healthcare as a result of poverty, lack of education, discrimination and other complex factors.

Merck believes it has an important role and responsibility in improving access to medicines, vaccines and quality healthcare worldwide. While there is still critical work to be done, good progress is being made to address health literacy and healthcare disparities globally.

Our vision is to be recognized by healthcare stakeholders as a leader in the areas of healthcare disparities and health literacy through innovative programs and resources, and through our demonstrated commitment to improving patient health outcomes.

We will accomplish these important goals through parallel strategies that focus on reducing healthcare disparities and improving health literary. In so doing, we support the overall U.S. market strategy of improving adherence and ensuring launch excellence for Merck brands.

Reducing Healthcare Disparities

This strategy is focused on educating healthcare professionals by increasing their awareness and understanding of the impact of healthcare disparities on quality of care and patient health outcomes. As an example, Merck recently launched a set of resources available to payers, integrated health systems, and large medical groups in markets with a high concentration of healthcare disparities. The goal is to facilitate improved communications between healthcare professionals and HCCs.

Merck also supports consumer efforts to reduce healthcare disparities by leveraging cultural competence in our communications and marketing outreach materials. Based on input from customers and the field, a recent photo shoot added many additional diverse images, including multiethnic and multigenerational individuals, as well as more realistic urban settings and additional diversity within specific cultures. Finally, we have been successful in partnering with healthcare professionals, and working toward reducing healthcare disparities by creating innovative and culturally relevant disease-related resources that meet the health communications needs of customers.

Improving Health Literacy

At Merck, we are working to ensure that communications—how we speak to HCCs and the images we use to depict them—resonate in a culturally respectful and clear way, using appropriate language whenever possible and speaking in the active voice. These communications conform to established health literacy guidelines that have been created specifically for HCCs and for the healthcare professionals who care for them.

Finally, there are ongoing plans examining how we can impact health literacy earlier in the clinical-development process. In addition, we are assessing how health literacy impacts the overall healthcare consumer adherence to medications. These projects involve partnerships across the organization, including clinical research, the office of the chief medical officer and marketing.

Health Literacy—Efforts in Europe

Health literacy is the capacity to make sound health decisions in the context of everyday life—at home, in communities, at the workplace, in the healthcare system, in the marketplace and in the political arena.

Health literacy empowers people to make healthy choices and play a more active role in their health.

Merck has been committed to improve health literacy for more than 10 years to help increase access to healthcare through far-reaching policies, programs and partnerships across all markets. We partner with a wide range of stakeholders and support projects that empower people to make informed health decisions.

Throughout 2011, several Merck/MSD subsidiaries across Europe initiated projects in the area of health literacy:

• At the EU level, the University of Maastricht organized the European Conference on Health Literacy with the support of MSD (Europe). The European Health Literacy Commissioner, John Dalli, opened the conference with a keynote.
• The European Health Literacy Survey (HLS) project received two awards; one for the Societal Impact of the HLS-EU project—the so-called Crebolder Award from CAPHRI, a research school on public health and primary care; and another from the Dutch health organization Huis voor Zorg.
• Together with the University of Patients (Autonomous University of Barcelona), MSD Spain organized an International Health Literacy Seminar that brought together some 56 multidisciplinary attendees, including journalists and health authorities. This workshop was part of a long-term project whose objective is to emphasize the role of informed decision-making and health communications in healthcare.
• Based on the initiative of MSD Switzerland, a broad stakeholder alliance with health insurers, doctors, pharmacists and patient groups launched a pilot to improve health outcomes of asthma patients through better health literacy. The pilot is linked to a scientific study and is financed by the second largest health insurer of Switzerland.
• With support from Merck, the Serbian Association for Childhood Asthma undertook the Serbian Childhood Asthma Network project. The project is based on the experiences of the Merck Childhood Asthma Network. In response to an initial survey that indicated a lack of health literacy, the project provided education to teachers, parents, kids and school physicians about childhood asthma. After implementation in the 28 elementary schools in Belgrade, the Ministry of Health of the Republic of Serbia accepted the network as a model for national programs for literacy regarding childhood asthma.

Merck Medicus™ is an online, promotion-free guide to medical information for U.S. medical professionals.. Resources include a library of clinical references and guidelines, professional development tools, presentation materials and patient resources.

The third-party resources offered on Merck Medicus allow medical professionals to access the latest medical news, conference and congress reports, and practice guidelines. A digital-image library, including 2D and 3D resources, adds to the offerings. Leading medical publishers such as The Lancet and Harrison’s are featured on the site, and content is organized by medical specialty and is easily searchable. All Medicus resources and tools can be accessed from any mobile device and smartphone.

Univadis^® is an innovative online medical-information resource from MSD for healthcare professionals worldwide. This online resource provides high-quality, relevant and trusted medical information essential for healthcare practice. With an easy-to-use interface, the Univadis site features breaking medical news, accredited education courses and cutting-edge tools tailored to each medical specialty and clinician need.

One of the most trusted sources of medical knowledge worldwide, Univadis provides content that is independently developed by top scientific leaders and is provided in local languages free of charge to medical professionals.

Through Univadis, healthcare professionals have exclusive access to more than 400 peer-reviewed online education courses. We partner with some of the world’s leading medical publishers, including BMJ Learning and The Lancet, to provide independent and up-to-date information.

Working to Improve Health Literacy

Since 2009, MSD Germany has been working with representatives from patient organizations and senior spokespersons to make patient information leaflets easier to read and understand. As a result of this initiative, more than 25 leaflets for different indications have already been reviewed. In November 2011, the German patient commissioner expressed his appreciation for the improvement of the patient prescription leaflets and acknowledged that the improved leaflets have had positive effects on health literacy, patient safety and compliance.