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Direct mail improves knowledge of basic life support guidelines in general practice: a randomised study

Niels Secher12, Mette Marie Mikkelsen3, Kasper Adelborg4, Ronni Mikkelsen5, Erik Lerkevang Grove6, Jens Mørch Rubak7, Peter Vedsted8 and Bo Løfgren249*

Author Affiliations

1 Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark

2 Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark

3 Faculty of Health Sciences, Aarhus University, Aarhus, Denmark

4 Department of Internal Medicine, Regional Hospital of Randers, Denmark

5 Emergency Department, Aarhus University Hospital, Aarhus, Denmark

6 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

7 Central Region Denmark, Viborg, Denmark

8 Research Unit for General Practice, Aarhus University, Aarhus, Denmark

9 Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:72  doi:10.1186/1757-7241-20-72

Published: 14 October 2012



Implementation of new guidelines into clinical practice is often incomplete. Direct mail is a simple way of providing information to physicians and may improve implementation of new guidelines on basic life support (BLS). The aim of this study was to describe knowledge of the most recent European Resuscitation Council (ERC) Guidelines for BLS among general practitioners (GPs) and investigate whether direct mail improves theoretical knowledge of these guidelines.


All general practice clinics (n=351) in Central Denmark Region were randomised to receive either direct mail (intervention) or no direct mail (control). The direct mail consisted of the official ERC BLS/AED poster and a cover letter outlining changes in compression depth and frequency in the new guidelines. In general practice clinics randomised to intervention, every GP received a direct mail addressed personally to him/her. Two weeks later, a multiple-choice questionnaire on demographics and BLS guidelines were mailed to GPs in both groups.


In total, 830 GPs were included in this study (direct mail, n=408; control, n=422). The response rate was 58%. The majority (91%) of GPs receiving direct mail were familiar with BLS Guidelines 2010 compared to 72% in the control group (P<0.001). Direct mail improved knowledge of the new recommended chest compression depth (67% vs. 40%, P<0.001) and chest compression frequency (62% vs. 40%, P<0.001).


Direct mail improved knowledge of changes in BLS guidelines and thus facilitated the implementation of this knowledge into clinical practice. Resuscitation councils and medical societies may consider using direct mail as a simple strategy to facilitate implementation of changes in clinical guidelines.

Basic life support; First aid; Cardiopulmonary resuscitation (CPR); Education; Guidelines; General practice