Community pharmacy customer segmentation based on factors influencing their selection of pharmacy and over-the-counter medicines

Counselling with a focus on product and price transparency for over-the-counter headache medicines: A simulated patient study in community pharmacies in Munich, Germany

BACKGROUND

In Germany, over-the-counter (OTC) medicines may only be dispensed by community pharmacies (CPs). German CPs must ensure 'adequate' counselling, including the cost of medicines. Along with information gathering and advice giving as classic aspects of counselling, the aim was also to investigate counselling indicators of product and price transparency.

METHODS

The cross-sectional study was based on the covert simulated patient (SP) methodology and was conducted in a random sample of CPs stratified by districts in the major German city of Munich. Each of the 178 selected CPs was visited once by one of five trained female students. They simulated a symptom-based sub-scenario 1 with a request for an OTC medicine for a headache and a sub-scenario 2 with standardised information regarding product and price transparency. The assessment, completed immediately postvisit by the SPs, included a total of 23 items.

RESULTS

All 178 scheduled visits were completed successfully. The median counselling score with the classic items was 3.0 out of 12 points (interquartile range [IQR] 4.25) and when expanded by items for product and price transparency the score was 4.0 out of 14 points (IQR 4.00). A selection of medicines was offered unsolicited in 38.2% of the visits and in 5.6% of the visits voluntary price information was provided before the transaction. A request for a cheaper medicine led to a significant price reduction (Wilcoxon signed-rank test; p < 0.001, r = 0.869).

CONCLUSION

Due to the below-average level of counselling, the regional chambers of pharmacists are recommended to initiate measures for improvement. There is also potential for optimisation with regard to product and price transparency as an important extension of the classic counselling aspects. It is therefore recommended that the government raise customers' awareness of the cost of medicines.

Service quality, outpatient satisfaction and loyalty in community pharmacies in Turkey: A structural equation modeling approach

Background

The sustainability of community pharmacy services is dependent on service quality, patient satisfaction, and patient loyalty. While community pharmacies are perceived as medical units in terms of drug dispensing, they are also businesses that engage in social interaction with patients.

Objectives

To propose a certain model to evaluate the impact of different service factors on the level of satisfaction and to reveal the relationship between satisfaction and loyalty.

Methods

This cross-sectional study was conducted in the province of Afyonkarahisar, Turkey, between March 20, 2022, and December 30, 2022. The research data were collected with a questionnaire that included demographic information, selected service factors, satisfaction, and loyalty. The data obtained from 402 participants were analyzed using structural equation modeling (SEM).

Result

The mean age of the participants was 32.02 ± 11.81, 53.9% were female, 58.7% were employed, 54.1% had a bachelor's degree, 11.7% had a chronic disease, and 16.1% were taking medication regularly. The findings of the study showed that communication and attitude (β = 0.22; t = 3.90), medicine supply (β = 0.43; t = 7.62), and pharmacy environment (β = 0.26; t = 4.23) positively affected patient satisfaction in community pharmacies. Service promptness did not have a significant effect on patient satisfaction (β = 0.07; t = 1.18). The most effective service factor on patient satisfaction was medicine supply (β = 0.43). In addition, the research results determined that patient satisfaction strongly affects patient loyalty in community pharmacies (β = 0.72, t = 11.24).

Conclusions

While community pharmacies can increase patient satisfaction through service factors, they can increase patient loyalty by improving patient satisfaction. Community pharmacies that want to have satisfied and loyal patients should focus more on service factors. Community pharmacies should not only meet the medical expectations of patients but also meet their social expectations.

From purely physical to purely online pharmacies: exploring different shopper profiles and discussing some widespread beliefs

Purpose

Up until now, some internet shopper profiles based on certain findings have been generally accepted. It is widely believed that internet shoppers tend to be more innovative, less averse to risk, more variety-seeking, more information-seeking, more impulsive and more interested in pursuing convenience. This paper aims to discuss some of these assumed characteristics by contrasting and comparing customers of three different types of pharmacies.

Design/methodology/approach

Three exploratory-descriptive design studies are conducted to profile customers from three different types of pharmacies in Mexico. Data from three samples are assessed, including 198 customers of physical drugstores without an e-channel, 150 customers of physical pharmacies with an e-channel and 271 customers of online pharmacies.

Findings

Shoppers from physical pharmacies purchase more food and drinks than actual medicine. Shoppers from physical pharmacies with e-channels tend to use the internet to acquire information about pharmaceutical products but do not make purchases online; they prefer to obtain products immediately from a physical drugstore instead of waiting for delivery from an e-channel. Contrasting with the two former customer types, shoppers who use e-pharmacies are specific in the numbers and types of products they purchase, medicines being the main priority.

Originality/value

The three types of customers and their preferred shopping platforms may show important profile differences. Despite the evidence in previous literature, shoppers at physical pharmacies are not necessarily non-convenience oriented (time and effort), noninformation analyzing, non-price conscious or less positive in their attitude about shopping; instead, they may simply be averse to technology.

Determination of Factors Influencing Pharmacists While Recommending Immune-Enhancing Products via Analytic Hierarchy Process

Objectives

Immune enhancers are attracting attention day by day. Besides, during the coronavirus disease-2019 (COVID-19) pandemic, there has been an increasing demand for immune enhancers. Pharmacists are seen as trustable providers of complementary and alternative medicines, dietary and herbal supplements, immune-enhancers, and so on. This study aims to prioritization criteria that affect community pharmacists' recommending behavior regarding immune enhancers.

Materials and Methods

This paper adopts the analytic hierarchy process (AHP) to rank different criteria substantial for affecting community pharmacists' recommending behavior regarding immune enhancers. In this direction, firstly seven criteria were identified through literature review and views of pharmacists who have community pharmacy experiences. These are; (i) ease of access, (ii) selling price, (iii) package, (iv) content (appropriateness to patient health status), (v) expectation of patient, (vi) quality, and (vii) trust in the manufacturer. Then, a questionnaire including criteria was prepared and delivered to community pharmacists. The data obtained from 93 participants were transferred to the Super Decisions software. The hierarchical structure of the AHP was established and pair-wise comparisons were made.

Results

This study showed that the most important criterion was the ease of access (28%). Secondly, pharmacists give importance to the content of the product, while advising immune-enhancers (22%). Besides, it was determined that the least important criterion was the package of the product (4%).

Conclusion

This study will contribute to the literature by facilitating the process of assessing factors that pharmacists pay attention to while recommending immune-enhancing products. Additionally, the present study results will shed light on firms producing such products, to shape their supply chain management strategies, especially for marketing and sales.

The role of electronic word of mouth (eWOM) and the marketing mix on women’s purchasing intention of children's dietary supplements

Purpose

This study aims to examine and validate the role of electronic word of mouth (eWOM), a mediating factor between the marketing mix elements (product, price, place and promotion) and women's purchasing intention of children's dietary supplements in the Jordanian environment culture context.

Design/methodology/approach

The data of the research was collected through online and offline questionnaires using a connivance sample of 370 women who have children and live in Amman, the largest city in Jordan.

Findings

The findings showed a partial effect of the eWOM as mediating factor on the relationship between marketing mix elements and women's purchasing intention of children's dietary supplements. The findings also revealed significant positive effects of price and place as marketing mix elements on women's purchasing intention of children's dietary supplements, while the product and promotion elements were found insignificant.

Originality/value

This paper contributed to consumer buying behaviour theories by filling a gap in the literature regarding the role of eWOM as a mediating factor on the relationship between marketing mix elements and women's purchasing intention of children's dietary supplements in a developing country like Jordan for the first time.

Effects of Demographic Characteristics and Consumer Behavior in the selection of Retail Pharmacies and Over-the-Counter Medicine

Aim

The study aimed to provide new insights into consumer behaviour by identifying the key demographic factors that influence the choice of pharmacy and over-the-counter (OTC) medicine.

Materials and Methods

A cross-sectional study was conducted in an urban area (Thessaloniki, Greece), surveying a convenience sample of 314 consumers with a structured questionnaire. Data analysis was conducted using the chi-square test, one-way analyses of variance (ANOVAs) and Spearman's rho correlation coefficient.

Results

Respondents with a lower educational level and retired consumers tended to make their purchases in a single pharmacy (p < 0.001). Older participants were more likely to consider the pharmacy staff and additional services to be important factors (p < 0.01). Students were the only group to prefer a formal relationship with the pharmacy staff (p < 0.001). Participants with a lower educational level tended to know exactly what they would buy (p < 0.05), whereas women made more unscheduled purchases of OTCs (p < 0.05). Respondents with a higher income assigned more importance to the product's country of origin (p < 0.05) and manufacturing company (p < 0.01) and less importance to the pharmacist's opinion than those of a lower income (p < 0.05).

Conclusions

The educational level, occupation and age of consumers have a marked effect in their selection of pharmacy, and along with gender and personal income, in their choice of OTC medicine. Our findings yield implications for the management of community pharmacies.

Community Attitudes and Habits Toward Over-The-Counter Drugs: Results of a Study Conducted in Thessaloniki, Greece

OBJECTIVES

To determine the frequency of use, sources of information, and selection criteria of Greek residents regarding over-the-counter (OTC) drugs, as well as their opinion about their dispensing in nonpharmacy settings.

METHODS

This was a survey study in which an anonymous cross-sectional questionnaire was used to assess the knowledge, habits, and attitudes about OTC drugs. Data were collected from March 2017 to July 2017 in Thessaloniki, the second largest city in Greece. Logistic regression was used to investigate significant factors that affect the participants' behavior.

RESULTS

A total of 782 participants completed the questionnaire. The population had a mean (SD) age of 46 (17) years and 55.1% were females. About one-third (32.5%) of the participants used nonsteroidal anti-inflammatory drugs more than once per week. OTC drugs acting on the gastrointestinal tract were used to a lower extent (13.2%). The majority (84%) of the respondents consult a healthcare professional about the information on OTC drugs. Furthermore, when not sure about which OTC drug to use, 510 participants (65.6%) valued their physician's advice, whereas 480 participants (60.2%) valued their pharmacist's advice. Most participants (61.2%) were negatively inclined toward the purchase of OTC drugs in nonpharmacy settings, with younger participants being more receptive to out-of-pharmacy OTC drug purchase than older ones (odds ratio 2.20; 95% confidence interval 1.37-3.54).

CONCLUSIONS

Healthcare professionals play an important role in providing people information on their selection of OTC drugs. This could be the main reason why participants prefer to buy OTC drugs from community pharmacies rather than retail shops.

A Survey of Patients' Opinions and Preferences on the Use of E-Prescriptions in Poland

E-prescription is already used in many countries, improving the standard of patient care. Officially, from 8 January 2020 e-prescribing has been obligated in Poland. Physicians’ and pharmacists’ opinions on e-prescribing have been widely researched and reported in the literature. In contrast, patients’ perception has, to date, received little attention. For this reason, the aim of this study was to find the features and functionalities of e-prescribing that are desired by the public and influence the positive evaluation of this tool, according to patient opinion. In order to obtain data, a questionnaire was completed by 456 randomly selected adults. The obtained results indicated that only eight people (1.8%) did not know what e-prescription is. Of the remaining 448 individuals, 72.1% prefer e-prescription because it is more convenient for them. Most patients (62.1%) also recognize that e-prescribing makes it easier to purchase medications on behalf of another patient. Based on the study, it can be concluded that e-prescription is well evaluated by Polish patients. A large percentage of respondents were positive about obtaining prescriptions for continued treatment, without a personal doctor visit. Therefore, it is reasonable to maintain the possibility of such contact with a physician. The most popular, and preferred, method of receiving e-prescriptions is via SMS. However, it is necessary to offer different options for obtaining prescriptions, to meet the needs of different populations.

Pharmacy service factors and pharmacy performance: the role of patient satisfaction in community pharmacies

Purpose

This study aims to examine the effects of pharmacy service factors (namely, medication teaching, service promptness, pharmacist attitudes, medication supply and pharmacy location) on patient satisfaction with community pharmacies in Jordan and to explore the effect of patient satisfaction on pharmacy performance.

Design/methodology/approach

Descriptive analytical methodology, with a quantitative approach using survey strategy was applied. The study population represented the whole population of Jordan (2.033 million households). Data were collected using an online questionnaire. A convenient quota sample of 1,000 respondents was targeted; 502 valid questionnaires were returned, representing an effective response rate of 50.2%. The study hypotheses were tested using path analysis.

Findings

The results showed that the service factors contributing most significantly to patient satisfaction in Jordan are medication supply, pharmacist attitudes, medication teaching and service promptness, in descending order of influence. Meanwhile, the effect of pharmacy location on patient satisfaction proved to be insignificant. In addition, patient satisfaction proved to have a highly positive impact on pharmacy performance.

Originality/value

This study addresses a debatable issue in the literature regarding the influence that pharmacy service factors can have on patient satisfaction. In addition, to the best of the researchers’ knowledge, this is the first study to explore the proposed effects in Jordan. It is also one of the first to investigate the effect of patient satisfaction on community pharmacy performance.

Predisposing, Enabling, and Need Factors Associated with the Choice of Pharmacy Type in the US: Findings from the 2015/2016 National Consumer Survey on the Medication Experience and Pharmacists' Roles

Background: Knowing the type of pharmacy used by the patient is meaningful to the pharmacist. Previous studies have assessed different factors predicting the kind of pharmacy selection and reached inconsistent findings. Objectives: To identify patient and health-related factors associated with pharmacy type selection. Methods: The Andersen Behavioral Model of Health Service Use was used to organize the selection of patient characteristics and categorize them as predisposing, enabling, and need factors. The dependent variable was the type of pharmacy used. Logistic regression was used to predict the association between patient-related characteristics and the type of pharmacy used. Results: Older age respondents were less likely to use independent pharmacies (OR = 0.992) and more likely to use mail pharmacy services (OR = 1.026). Highly educated people showed higher use of chain and mail pharmacies (OR = 1.272, 1.185, respectively) and less tendency to use the independent, supermarket, and prescription-only pharmacy types. Men were less likely to use chain pharmacies (OR = 0.932) and more likely to use supermarket pharmacies than women. Patients who use Medication Therapy Management (MTM) services had higher odds of using independent and supermarket pharmacies (OR = 2.808, 1.689, respectively). Patients with a higher number of chronic diseases and experienced side effects of medications were more likely to use independent pharmacies (OR for number of disease = 1.097 and for side effects = 1.095). Conclusions: This study’s findings identify characteristics associated with selecting certain pharmacy settings and direct future research to include other predictors encompassing beliefs, attitudes, and other social factors.

Impact of COVID-19 on the Customer End of Retail Supply Chains: A Big Data Analysis of Consumer Satisfaction

The COVID-19 pandemic has been one of the biggest disruptive events of recent decades and has had a global effect on society and the economy. The political regulations resulting from COVID-19 also led to significant changes in physical grocery shopping. However, the specific impact of COVID-19 on consumer satisfaction at the customer end of retail supply chains, i.e., the point-of-sale (PoS), has not yet been addressed. By gathering and analyzing consumer satisfaction data (ratings) and sentiments (evaluation comments) available on the open web, the current study evaluates the impact of COVID-19 on consumer satisfaction at the PoS. Focusing on the five biggest retail chains in Austria, the results show that there was a general and significant decline in consumer satisfaction due to the pandemic. The results also show a high impact of political regulations on consumer satisfaction. Furthermore, the text-mining based analysis of evaluation comments indicate that store layout and facilities, as well as product availability and waiting time had a great impact on consumer satisfaction. In total, over 533,000 consumer satisfaction ratings and over 153,000 textual comments have been analyzed, providing the basis for a comprehensive and sound discussion of the impact of COVID-19 on consumer satisfaction and perceptions. Future research could focus on applying the used data analysis technique and the adapted consumer sentiment dimensions in different settings, such as countries other than Austria or smaller retail chains.

How does perceived cost and value influence pharmacy patronage? A scoping review

Purpose

To date, community pharmacy research has largely focused on the impact of service quality elements on patronage behavior. Investigation into the influence of cost and value is limited. The purpose of this study is to explore what is known about customers’ perceptions of cost and value, and how these influence patronage patterns in community pharmacy.

Design/methodology/approach

A scoping review framework was used to conduct a systematic search of four databases with the addition of articles sourced from reference lists. The database search was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews protocol. Studies were analyzed in terms of author name, date of publication, study location, study population, methods and key findings.

Findings

The 26 studies retrieved were qualitative or quantitative in nature and included a broad sample population. Both cost and value were found to be key factors influencing pharmacy choice. Pharmacy customers were found to perceive costs in terms of monetary, psychological, emotional and convenience-related sacrifices. Value was either perceived as relating to the worth or utility of a good or service, or in terms of a trade-off relationship between what was received and given up by the consumer.

Research limitations/implications

A comprehensive interrogation into the true meaning of “value” to consumers is warranted to improve quantitative measurement instruments.

Practical implications

Pharmacies may attempt to influence customer behavior by minimizing unfixed costs to the consumer such as the price of goods and services and time costs.

Originality/value

This review highlights the need for academic enquiry into how consumers trade-off perceived costs for service in community pharmacy.

Determinants of national drug products acceptance across patients, pharmacists, and manufacturers: A mixed method study

Introduction

The national pharmaceutical industry is pivotal for both the health sector and the national economy. This study aims to identify determinants of national drug products acceptance. The objectives of this study were to quantitatively measure the level of patient and community pharmacist acceptance of national drug products available in community pharmacies and to qualitatively explore the barriers facing national pharmaceutical companies and investigate the suggested solutions.

Methods

This cross-sectional study used an explanatory mixed method design. It was conducted in Baghdad, Iraq from July through October 2018. The study included two surveys (one for pharmacy customers and another for pharmacists) and thereafter semi-structured interviews of national pharmaceutical company owners/managers. The interview guide was developed based on preliminary quantitative results. Thematic analysis was used to analyze the interview findings.

Results

We received 123 patient surveys and 125 usable pharmacist surveys. We conducted seven interviews and stopped when we reached saturation. Integrated qualitative and quantitative findings showed that the main determinants of national drug product acceptance are product characteristics (namely price, packaging, brand, and availability), healthcare providers effect on product promotion and perceived effectiveness, and regulations enforced by authorities mainly the Ministry of Health.

Conclusions

Product price was the number one modulating factor in patient decision-making when purchasing a drug product. It appears that physicians and pharmacists are playing negative or at least neutral role in promoting national drug products and sustaining patients trust in national drug products. Current policies appeared to slow national drug industry growth and limit manufacturers’ ability to expand their share in the market. Manufacturer marketing efforts can help in gaining physicians and pharmacists support of the national drug product. Reforms to current drug policy and regulations were proposed by manufacturers.

Factors influencing the intention to buy over-the-counter medicines: empirical study

Purpose

This study aims to examine the antecedent factors (internal and external) that influence intentions to buy over-the-counter (OTC) medicines in Jordan.

Design/methodology/approach

A conceptual framework was developed based on consumer buying behavior theoretical background and a review of the relevant literature. A quantitative approach and a convenience sampling method were used to obtain data from self-administered questionnaires, which were completed by 351 academic staff from selected Jordanian universities.

Findings

The results indicate that all antecedent factors (internal, external and combined) have significant positive influences on the intentions to buy OTC medicines. Internal factors are more influential than external factors; however, the combination of internal and external factors resulted in the greatest influence on buying OTC medicines compared to each category separately.

Originality/value

This paper has integrated and examined empirically the antecedent factors that influence intentions to buy OTC medicines (internal, external and combined) in Jordan’s business environment context as a developing country for the first time.

Consumer internet purchasing of medicines using a population sample: A mixed methodology approach

BACKGROUND

Malta has an average of 3-4 private community pharmacies per locality, providing patients with easy access to medicines yet according to general statistics gathered from European organisations, Internet is used to purchase various online products with medicines being amongst them.

OBJECTIVES

To identify patterns around internet purchasing of medicines among Maltese residents.

METHODS

The study followed a mixed methods approach, employing a cross-sectional survey followed by semi-structured interviews. A random sample of 1996 residents were selected from the Maltese electoral register to participate in a postal questionnaire designed to gather data about purchasing prescription-only-medicines (POM) as well as over-the-counter (OTC) medicines. Results were analysed using descriptive statistics and Chi-square to establish associations between responses. Five interviews investigated participants' concerns related to sourcing of medicines. The participants were purposively chosen from the questionnaire respondents. Data were analysed using thematic analysis.

RESULTS

The survey had a 22% response rate (N = 444) (60% female; mean age 52 years ± 17). Two (0.45%) participants reported purchasing POMs online in the past, while 4.3% (n = 19) purchased OTCs including vitamins, supplements and herbal combinations. The main reasons for OTC online purchasing were lack of local availability (n = 6; 1.4%) and lower price (n = 11; 2.5%). A total of 89% (n = 395) of respondents provided a reason for not purchasing online, with safety issues being the primary reason for 41% (n = 181) of these. Interviewees expressed disregard towards internet purchasing of medicines that was evident from the themes that emerged: definition of 'medicines', health autonomy and trust in self-care, relationships and trust in health professional, restrictions of medicine supply, influence of cost, need for options.

CONCLUSIONS

The Maltese appear to be rather cautious and do not purchase POMs online, citing the risks that may be associated with internet purchasing. With regards to OTCs, a small percentage purchase these online and exposing them to risks associated with unauthorised sites.

Association between PDE4D polymorphism and ischemic stroke in young population

Objective

To explore the association between the polymorphisms of the phosphodiesterase (PDE) 4D gene (SNP83 and SNP87) and the risk of ischemic stroke (IS) in Chinese young population.

Methods

This study included 393 patients who were divided into IS group and non-IS group. Semiconductor high-throughput sequencing technology and multivariate logistic regression analysis were performed.

Results

In the case group, the frequency of CC genotype and C allele of the SNP83 gene was significantly higher than that in the control group. There was no significant difference in genotype frequency distribution of SNP87 between the two groups.

Conclusion

We found an association between SNP83 and the risk of IS in Chinese young population from northern Henan province. There was not a significant association between SNP87 and IS in Chinese young population.

Influence of laser needle-knife on PI-3K, AKT and VEGF mRNA expression in cervical spondylotic arteriopathy model rabbits

Objective

To determine the effect of laser needle-knife on PI-3K, AKT and VEGF mRNA expression of vertebral arteries in a rabbit model of cervical spondylotic arteriopathy (CSA) and the mechanism of action involved.

Methods

Forty healthy general-grade rabbits were divided into a normal control group, model group, acupuncture group, and laser needle-knife group (n = 10 rabbits per group), and the CSA rabbit model was established in all but groups but the normal control group. CSA model rabbits in the acupuncture group were treated by acupuncture at the Fengchi (GB 20) and Cervical Jiaji (EX-B 2) points, whereas rabbits in the laser needle-knife group were treated with laser needle-knife targeting the Jiaji points near the C5 spinous process. Rabbits in the normal control and model groups were fixed using similar methods. Behavioral characteristics of all rabbits were evaluated before and after treatment. Peak systolic velocity (PSV) of the right carotid and vertebral arteries in each group were examined using beside B ultrasound, and PI-3K, AKT, VEGF mRNA expression in vertebral arteries were determined by real-time PCR.

Results

The behavioral signs of rabbits were improved after treatment in both the acupuncture and laser needle-knife groups. In comparison with control group, PSV of right carotid arteries in acupuncture group and laser needle-knife group were enhanced significantly (P < 0.05 and P < 0.01), PSV of right vertebral arteries in acupuncture group and laser needle-knife group were enhanced significantly too (P < 0.01 and P < 0.05). PI-3K mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group (P < 0.01, P < 0.05). AKT mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group (P < 0.01). VEGF mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group too (P < 0.01, P < 0.05). No significant differences were found in PI-3K, AKT and VEGF mRNA expression levels among acupuncture and laser needle-knife groups (P > 0.05).

Conclusion

Laser needle-knife could effectively intervene the mRNA expression of PI-3K, AKT and VEGF, this may be one of the mechanisms of the effect of laser needle-knife in treating CSA in rabbits.

Effects of laser needle-knife therapy on vertebroarterial morphology and protein expression of PI-3K, AKT and VEGF in the carotid artery in a rabbit model of cervical spondylotic arteriopathy

Purpose

To explore how the use of a laser needle-knife affects vertebroarterial morphology and protein expression of PI-3K, AKT and VEGF in the carotid artery of a rabbit model of cervical spondylotic arteriopathy (CSA), and to determine its primary treatment mechanism.

Methods

The CSA rabbit model consisted of 30 rabbits with CSA that were randomly divided into a model group (n = 10), an acupuncture group (n = 10) and a laser needle-knife group (n = 10) plus a further 10 wild type rabbits placed into a normal group. Rabbits in the acupuncture group were treated by needling the Fengchi (GB 20) and Jiaji (EX-B2) acupoints, while those in the laser needle-knife group were treated with a laser needle-knife on the Jiaji (EX-B2) near the spinous process of the fifth cervical vertebra, the rabbit in both groups immobilized during treatment. Rabbits in the other two groups received no treatment, but were immobilized for a similar duration. The morphology of the right vertebral artery and the distribution of pore size before and after treatment were compared using BET and SEM, and the protein expression of PI-3K, AKT and VEGF in the carotid artery of the four groups measured using Western blot analysis.

Results

The pore diameter and specific surface area of the right vertebral artery increased after treatment, as did the number of micropores. Compared with the normal group, the protein expression of PI-3K, AKT and VEGF in the carotid artery of the model group was significantly lower (P < 0.05), while that of the laser needle-knife group was significantly higher (P < 0.05 and P < 0.01). In addition, rabbits from the acupuncture and laser needle-knife groups demonstrated significantly higher levels of protein expression of PI-3K and VEGF in the carotid artery compared with the model group (P < 0.05 and P < 0.01).

Conclusions

By promoting micrangium hyperplasia within the vertebral artery of rabbits with CSA, treatment with a laser needle-knife modified the protein expression of PI-3K, AKT and VEGF, suggesting that laser needle-knife therapy possibly treats CSA though these signaling pathways.