Gezondheidsproblemen van daklozen op zogenaamde dr.Valckenier-spreekuren in Amsterdam

To describe the characteristics and health problems of homeless people.

Design

Retrospective descriptive cross-sectional study at two primary care surgeries for the homeless in shelters in Amsterdam supported by the Municipal Health Service.

Method

During the period April 1997 to August 1999, the socio-demographics, reasons for encounter, medication, substance use and prevalence of HIV and lifetime tuberculosis were recorded in a standardised manner. Referrals to a shelter infirmary at the Salvation Army or a general hospital were investigated.

Results

The study population (n = 364) had an average age of 43 years (SD: 12) and 84 of the population were men. During the first consultation the following problems presented: skin problems in 26 of the population (traumatic injury, infected wounds, tramp's feet, scabies, lice, abscess, cellulites and erysipelas) and respiratory infections in 21 of the population (sinusitis, acute bronchitis and pneumonia). Medication was requested by 9 of the population of which 63 preferred tranquillisers. Medication prescribed by other physicians was stated by 46 of the population (21 tranquillisers, 14 methadone). Alcohol dependency was present in 25 (n = 92) and drug dependency in 29 of the population (n = 105). Intravenous drug use was prevalent in 14 of the population. Of the drug users, 49 received addiction care as opposed to 2 of the alcoholics. HIV prevalence was 5 and the lifetime prevalence of tuberculosis was also 5. Shelter infirmary admittance was indicated in 15 of the population (n = 53; 91 men), with a combination of trauma 38, skin disease 38, pneumonia 21 and tramp's feet 17. Five homeless men (1.4), alcoholic street dwellers, presented with various life-threatening health problems in an advanced stage.

Conclusion

Homeless people in Amsterdam have poor health and suffer from various problems. Outreach primary health care adjusted to the lifestyle and multiple health problems of the homeless was clearly very important for public health. Homeless alcoholics were not using addiction care services.