[Health problems of homeless people attending the outreach primary care surgeries in Amsterdam].

OBJECTIVE

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.