Background: Electrophysiology (EP) procedures, including cardiac implantable electronic devices (CIEDs) and ablations, are widely used to manage arrhythmias and heart failure. These interventions, though effective, require substantial resources, prompting the need for systematic economic evaluations to inform healthcare decision-making. Methods: A systematic review of studies from 2007 to 2024 was conducted in two phases. Phase one assessed trends in economic evaluations of EP procedures, analyzing 129 studies across regions and timeframes. Phase two focused on cost-effectiveness analyses of implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy defibrillators (CRT-Ds), and atrial fibrillation (AF) ablation, examining outcomes like quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), while identifying factors influencing economic results. Results: EP procedures generally demonstrated favorable cost-effectiveness, particularly in high-income regions. Studies on ICDs and CRT-Ds consistently supported their economic value for patients with arrhythmias or heart failure, while AF ablation showed potential for long-term benefits, particularly when compared to medical therapies. However, results varied by region, reflecting differences in healthcare systems, costs, and patient populations. Conclusions: The review highlights the overall cost-effectiveness of EP procedures in many settings but underscores the need for tailored economic evaluations in low- and middle-income countries. Simplified methodologies and greater attention to regional contexts are recommended to guide resource allocation and policy development globally.

Background: Health Impact Assessment (HIA) procedures can include the assessment of inequalities and inequities associated with the distribution of environmental health risks and benefits, aimed at attenuating the exacerbation of environmental health disparities. This systematic review, conducted as part of the Joint Action Prevent Non-Communicable Diseases initiative, explores methods for assessing health inequalities and equity within HIA frameworks, particularly in local projects affecting the distribution of environmental risks and benefits. Methods: Adhering to the PRISMA guidelines, a systematic review of the scientific literature was conducted using the MEDLINE/PubMed, Scopus, and Embase databases, searching until March 8, 2024. Furthermore, a grey literature analysis encompassed the Institutional Repository for Information Sharing (IRIS) of the World Health Organization, to identify guidelines and recommendations addressing equity considerations in HIAs. Studies were included based on predefined eligibility criteria if they explored issues related to inequalities, inequities, and vulnerabilities within the context of HIAs. Data extraction focused on methodologies that incorporated equity considerations within the HIA framework, particularly concerning local urban planning initiatives, transport infrastructure, and industrial settings. Results: A total of 33 studies met the inclusion criteria. Among these, eight documents from the grey literature, identified as guidelines and guidance, underscored the importance of prioritizing equity to ensure that health impacts are addressed fairly across diverse population groups. The remaining 25 peer-reviewed studies employed a combination of quantitative and qualitative methodologies. Quantitative approaches, including exposure-response modeling and Geographic Information System (GIS) mapping, were utilized to evaluate spatial and demographic health disparities. Qualitative methods, such as focus groups, interviews, and participatory tools, provided insights into the lived experiences of vulnerable populations affected by local interventions. Studies addressing urban and transportation planning predominantly emphasized socioeconomic stratification, whereas those focused on industrial settings highlighted occupational hazards and community vulnerabilities. Conclusion: This review highlights the diverse and fragmented approaches used to address health inequalities and equity in HIA. It underscores the need for interdisciplinary and systematic methodologies that integrate quantitative and qualitative perspectives, ensuring equity remains a central consideration in policymaking and project implementation. Finally, it proposes a practical framework for integrating equity into HIA.

Background: Dementia is a group of chronic diseases characterised by cognitive impairment that progressively disrupts daily functioning and requires increasing levels of healthcare, social support, and long-term care. Support for people with dementia can be provided by formal support systems although most of the care process relies upon informal care givers. Despite the availability of formal support systems and healthcare workers, the utilization of dementia care services remains suboptimal. Factors such as non-compliance, lack of awareness, and poor care coordination contribute to this issue. Understanding these barriers is crucial for improving service utilization and alleviating the economic burden on families and national health systems. Methods: This systematic review analysed the literature, published from 2013 to 2023, on barriers in Alzheimer and other dementia healthcare system, conducted on people living with a dementia, their caregivers, or healthcare workers in dementia care settings in Europe, following PRISMA guidelines. Searches in PubMed, Embase, PsycINFO, Health Technology Assessment Database, and Web of Science used terms related to Alzheimer's, dementia, and access barriers. Rayyan AI supported full-text review, with quality assessed via the Mixed Methods Appraisal Tool. Results: Over 1298 articles, 29 studies met the inclusion criteria. These studies highlighted several barriers to dementia care, categorised into information, organizational, cultural, stigma-related, financial, and logistical challenges. Informational and educational barriers included a lack of awareness and knowledge among caregivers. Organizational barriers involved poor care coordination and unclear access procedures. Cultural and stigma-related barriers were linked to societal attitudes towards dementia. Financial barriers were associated with the high costs of care, and logistical barriers included limited availability and accessibility of support services. Conclusions: To enhance the quality of life for individuals living with dementia, it is crucial to address these identified barriers through tailored interventions and management programs. Improving care coordination, communication, and training for healthcare professionals, alongside reducing systemic delays, are essential steps toward more effective dementia care. Easing the burden of care with tailored interventions and management programmes is mandatory to improve the quality of life of persons living with dementia and their families.

Background & Objective: This systematic review evaluates the impact of guidelines on healthcare professionals' behavior and explores the resulting outcomes. Methods: Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis. Results: The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %). Conclusions: The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.

In Europe, most countries are facing common healthcare challenges that lead to a need for innovation, effectiveness and efficiency in the healthcare systems. This is often addressed through actions and intentions including enhanced primary and integrated care. However, these developments seem to be progressing slowly and non-uniformly, nor is there knowledge exchange, and the full implications of these changes on healthcare design are still unfolding. The research presented investigates what are the current trends in healthcare systems and the effects on design transformations, focusing on the Swedish experience. In Sweden, a reform known as "Nära Vård" [Close Care], aims to "reconstruct" the core of the healthcare service around primary care. It strives to bring care "closer" to people and communities concerning access to both care and the facilities where it is delivered. The objective of this paper is to understand what can be learnt from the Swedish experience; the research presented aims at investigating the effects of the Close Care reform on primary care facilities design. The study was conducted from April to July 2023, and it consisted of: i) desk research and literature review; ii) data collection through 12 interviews with experts; iii) data analysis through qualitative content analysis; iv) study visits to local care facilities. From the interviews, 10 factors for change and 9 challenges emerged. Moreover, it appears that the organisational structure of the Swedish healthcare system caters for regional and individual projects' interpretations of how to bring care "closer" to the patients; this variation allows for a broader understanding of the advantages and drawbacks of each organisational model and design, and it reinforces the idea that there is no "one-size-fits-all" for close care. This diversity points to a need for a project evaluation program of the ongoing experiences, aimed at assessing the performance and effectiveness of each approach.

This project of Health technology assessment was aimed at defining the impacts of offering a cystic fibrosis (CF) carrier screening to the general population, compared to the current situation, where the test is offered to individuals at high-risk to give birth to a child with CF. Results revealed: i) a lack of robust and updated data; ii) a return on investment up to six years from the screening's introduction, despite important economic and organizational efforts; iii) a general positive attitude of healthcare professionals, people with CF, families and general population; iv) possible issues related to the social impact.

Objectives: Respiratory syncytial virus (RSV) is a frequent cause of acute lower respiratory infection in children, imposing a substantial economic burden on healthcare systems. This systematic review aimed to assess the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. Study design: Systematic review. Methods: A systematic search of PubMed, Embase, Scopus, and the International HTA Database, including studies published in English or Italian, was conducted between January 2000 and July 2022. Inclusion criteria required studies to be conducted in Italy and provide data on the economic costs and healthcare resource utilisation related to RSV infections. Results: Out of 20,845 records screened, 18 articles met the inclusion criteria. Only one study provided comprehensive data on RSV disease costs, including hospitalisation, diagnostic tests, and medical procedures for infants with RSV-bronchiolitis. The mean cost per inpatient was higher for RSV-positive children (€5753.43 ± €2041.62) than that for RSV-negative children. Additionally, five studies reported a median length of hospital stay of 5 days for RSV-infected children, and four studies indicated a higher frequency of intensive care unit admissions for RSV-infected children than for those with other viral infections. Conclusions: This is the first systematic review to examine the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. While limited data were available, the findings underscore the urgency to conduct further research and gather additional evidence on the costs and healthcare resource utilisation associated with RSV infections. Such efforts are essential for informing the development of effective prevention strategies for paediatric RSV infections in Italy.

AIMS AND OBJECTIVES: To summarise the evidence published to date regarding nursing core competence in stoma care of any type of ostomy throughout the patient's ostomy surgery candidate care pathway from preoperative to follow-up. BACKGROUND: Nurses should play a key role in all ostomy patient care pathways to help them to adapt to the new physics and psychological conditions from the preoperative phases to the prevention of tardive stomal complications. DESIGN: Scoping review. METHODS: This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. The following databases were queried: PubMed, EMBASE and CINAHL, from August to October 2022. RESULTS: The search strategy in the consulted databases identified 3144 studies. Different types of ostomies were found and investigated: tracheostomy, gastrostomy, jejunostomy, ileostomy, colostomy and urostomy. The results of the included studies helped address the objective that allowed the ostomatherapy skills to be broken down into the different periods of the care pathway. CONCLUSION: Caring for an ostomy patient requires advanced skills and a trusting relationship. The skills outlined in this research suggest how essential the stoma care nurse specialist is in these patients' care.

BACKGROUND: The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. METHODS: In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. RESULTS: The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. CONCLUSIONS: It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives.

Background: Many governments have programmes collecting and reporting patient experience data, captured through Patient Reported Experience Measures (PREMs). Our study aims to capture and describe all the ways in which PREM data are used within healthcare systems, and explore the impacts of using PREMs at one level (e.g. national health system strategy) on other levels (e.g. providers). Methods: We conducted a narrative review, underpinned by a systematic search of the literature. Results: 1,711 unique entries were identified through the search process. After abstract screening, 142 articles were reviewed in full, resulting in 28 for final inclusion. A majority of papers describe uses of PREMs at the micro level, focussed on improving quality of front-line care. Meso-level uses were in quality-based financing or for performance improvement. Few macro-level uses were identified. We found limited evidence of the impact of meso‑ and macro- efforts to stimulate action to improve patient experience at the micro-level. Conclusions: PREM data are used as performance information at all levels in health systems. The use of PREM data at macro- and meso‑ levels may have an effect in stimulating action at the micro-level, but there is a lack of systematic evidence, or evaluation of these micro-level actions. Longitudinal studies would help better understand how to improve patient experience, and interfaces between PREM scores and the wider associated positive outcomes.

Aim: To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts. Background: Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence. Evaluation: A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus. Key issues: After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'. Conclusions: The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it. Implications for nursing management: The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

Background: This Policy Brief aims to contribute to the debate on the resilience of the healthcare systems during the pandemic by discussing whether mortality indicators are appropriate for assessing resilience or whether other statistics should be employed. Evidence: During the first wave of the COVID-19, much emphasis was placed on case-fatality rates to offer a preliminary assessment of the resilience of healthcare systems. However, these statistics are often biased and do not consider the real figure of the population that has been infected. Policy Options and Recommendations: Comparing data obtained with different approaches based on statistical inference and large-scale serological survey, the brief highlights, that great care must be taken when using case-fatality data, which in the absence of careful analysis, can lead to erroneous conclusions. Conclusion: Using case-fatality rate gives us no sounding information about the real capability of healthcare systems to save lives during the pandemic. However, even in the absence of detailed epidemiological data new advancements in statistical methods can be useful to provide a more sounding evaluation of the resilience of the healthcare systems.

Objective: To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures. Background: Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics. Methods: An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome. Results: A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT. Conclusions: STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight. Knowledge transfer statement: The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.

Cost-effectiveness (CEA) and cost-utility analyses (CUA) have become popular types of economic evaluations (EE) used for evidence-based decision-making in healthcare resource allocation. Newborn screening programs (NBS) can have significant clinical benefits for society, and cost-effectiveness analysis may help to select the optimal strategy among different screening programs, including the no-screening option, on different conditions. These economic analyses of NBS, however, are hindered by several methodological challenges. This study explored the methodological quality in recent NBS economic evaluations and analyzed the main challenges and strategies adopted by researchers to deal with them. A scoping review was conducted according to PRISMA methodology to identify CEAs and CUAs of NBS. The methodological quality of the retrieved studies was assessed quantitatively using a specific guideline for the quality assessment of NBS economic evaluations, by calculating a general score for each EE. Challenges in the studies were then explored using thematic analysis as a qualitative synthesis approach. Thirty-five studies met the inclusion criteria. The quantitative analysis showed that the methodological quality of NBS economic evaluations was heterogeneous. Lack of clear description of items related to results, discussion, and discounting were the most frequent flaws. Methodological challenges in performing EEs of neonatal screenings include the adoption of a long time horizon, the use of quality-adjusted life years as health outcome measure, and the assessment of costs beyond the screening interventions. The results of this review can support future economic evaluation research, aiding researchers to develop a methodological guidance to perform EEs aimed at producing solid results to inform decisions for resource allocation in neonatal screening.

Introduction: The use of oral tenofovir/emtricitabine (FTC/TDF) for pre-exposure prophylaxis (PrEP) among high-risk people without Human Immunodeficiency Virus (HIV), is emerging as an innovative strategy to decrease HIV epidemic. The study aims at evaluating the implications related to PrEP introduction, from a multidimensional point of view, as required by Health Technology Assessment (HTA) approach, with a particular attention on sustainability and social factors, influencing PrEP implementation. Methods: An analysis was conducted involving 35 Italian Infectious Disease Departments. The introduction of PrEP (applied both as "add-on" and "substitute" prevention strategy) into the clinical practice was compared with a baseline scenario, consisting of condoms among men who have sex with men, and serodiscordant couples, and the use of Needle Syringe Programme among injection drugs users The above scenarios were analysed by means of a Health Technology Assessment (HTA) approach. The 9 EUnetHTA Core Model domains were assessed through comparative information, retrieved from literature evidence, and collection of qualitative and quantitative information, derived from real-world evidence, in particular from 35 Infectious Disease Departments and potential PrEP' users involved. A final multi-criteria decision analysis approach (MCDA) was implemented to simulate the appraisal phase and providing evidence-based information with regard to the preferable technology. Results: Despite the improvement in patients' quality of life, PrEP would generate the development of other sexually transmitted and blood-borne diseases, with a consequent decrease of patients' safety in case of PrEP applied as a "substitute" prevention strategy. In addition, PrEP would generate an increase in staff workflow, with investment in medical supplies and training courses. PrEP would lead to significant economic investments both for the NHS (+40%), and for citizens (+2,377%) if used as an add-on strategy, assuming FTC/TDF patent cost. With the off-patent drug, the NHS would benefit from an advantage (37%), and a shrink of the patients' expenditure emerged (+682%). More economic resources are required if PrEP is applied as a substitute strategy, considering both the patent (NHS: 212%; citizens: 3,423%) and the off-patent drug (NHS: 73%; citizens: 1,077%). Conclusions. The most cost-containing strategy would be the use of PrEP, as an add-on strategy, with a consequent improvement in patients' safety, even if drug-related adverse events would be considered. The implementation of the off-patent drug would decrease the economic burden of the innovative prevention strategy. Hence, the organizational aspects related to its adoption would be deeply investigated, with the potential opportunity to create specific ambulatories devoted to PrEP users' especially for medium and big size hospitals.

The emergence of link between periodontal disease and diabetes has created conditions for analyzing new interdisciplinary approach making toward tackling oral health and systemic issues. As periodontal disease is a readily modifiable risk factor this association has potential clinical implications. The aim of this paper was systematically review the extant literature related to analytics data in order to identify the association between type 1 diabetes (T1DM) in childhood and adolescence with periodontal inflammation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a database search between 2004 and 2019. A manual search of the literature was conducted as an additional phase of the search process, with the aim of identifying studies that were missed in the primary search. One hundred and thirty-nine records were screened and 10 fulfilled the inclusion criteria. Most studies were of moderate methodological quality. Outcomes included assessments of diabetes and periodontal status. In diabetic populations, compared to healthy subjects, interindividual differences in periodontal status are reflected in higher severity of periodontal inflammation. The most reported barriers to evidence uptake were the intrinsic limits of cross-sectional report data and relevant research, and lack of timely research output. Based on the evidence presented within the literature, the aforementioned biomarkers correlate with poor periodontal status in type 1 diabetic patients. Whilst the corpus of the evidence suggests that there may be an association between periodontal status and type 1 diabetes, study designs and methodological limitations hinder interpretation of the current research.

Background: Developing nursing research skills, awareness and research utilisation are important for improving healthcare outcomes and are key to ensuring the full understanding and knowledge base necessary for optimal delivery of care. Nevertheless, little is known about research awareness in children's nurses. Aims and objectives: To address this issue, an integrative literature review was conducted for studies published between January 2007 and January 2017 to obtain up-to-date evidence about the extent of research awareness and utilisation among children's nurses. Methods: Using PubMed, Cochrane Library, ILISI and CINAHL databases, 21 studies related to children's nurses' research awareness were included in the final review, which was later developed and structured in keeping with PRISMA checklist and guidelines. Conclusions: The studies isolated show that nurses' knowledge about and utilisation of research vary and that there are many existent barriers to and facilitators of evidence-based practice in the paediatric setting. Some studies report that introducing a cultural and/or change in clinical practice change to improve research utilisation can have positive impacts on healthcare outcomes and the quality of nursing care of children. It is recommended that structured approaches to improving research utilisation be considered and additional research is needed to explore the benefits of these approaches. Relevance to clinical practice: Despite more than three decades of the evidence-based practice movement within nursing, barriers still exist among children's nurses in the use of research in practice. If the use of research to improve the delivery of children's nursing care is to become a reality, then nurses' research awareness needs to improve to underpin care delivery with optimal evidence in a cohesive informed manner.

BACKGROUND: Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature reviews have analysed studies of continuity of care interventions to reduce readmissions of older inpatients discharged home over the short and long term. OBJECTIVE: To evaluate the effectiveness of continuity of care interventions in older people with chronic diseases in reducing short and long term hospital readmission after hospital discharge. DESIGN: Meta-analysis of randomized controlled trials. DATA SOURCES: A comprehensive literature search on the databases PubMed, Medline, CINAHL and EMBASE was performed on 27 January 2019 with no language and time limits. REVIEW METHODS: RCTs on continuity of care interventions on older people discharged from hospital having hospital readmission as outcome, were included. Two reviewers independently screened the studies and assessed methodological quality using the Cochrane Risk of Bias tool. Selected outcome data were combined and pooled using a Mantel-Haenszel random-effects model. RESULTS: Thirty RCTs, representing 8920 patients were included. Results were stratified by time of readmissions. At 1 month from discharge, the continuity interventions were associated with lower readmission rates in 207/1595 patients in the experimental group (12.9%), versus 264/1645 patients in the control group (16%) (Relative Risk [RR], 0.84 [95% CI, 0.71-0.99]). From 1 to 3 months, readmission rates were lower in 325/1480 patients in the experimental group (21.9%), versus 455/1523 patients in the control group (29.8%) (RR 0.74 [95% CI, 0.65-0.84]). A subgroup analysis showed that this positive effect was stronger when the interventions addressed all of the continuity dimensions. After 3 months this impact became inconclusive with moderate/high statistical heterogeneity. CONCLUSIONS: Continuity of care interventions prevent short term hospital readmission in older people with chronic diseases. However, there is inconclusive evidence about the effectiveness of continuity interventions aiming to reduce long term readmission, and it is suggested that stronger focus on it is needed.