Marcel Slockers

130 Summary In chapter 3 we use data from the Rotterdam Street Doctors’ office in the years 2006-2017 to study homeless patients in Rotterdam with a need for medical care. We describe the demographic and medical characteristics and changes of the patients who visit the Rotterdam Street Doctors’ office hours. This is an retrospective study of registered patient contacts from 2006-2017.Street doctors registered age, gender and ICPC diagnoses of patients in a GP information system. The characteristics of these patients have been analysed for three periods of four years: 2006-2009, 2010-2013, 2014-2017. For each of these periods, the number of individual patients visiting the Rotterdam Street Doctors’ office hours at least once, have been documented. Data from the period 2014-2017, have been used to describe characteristics of homeless patients and have been compared with a regular GP practice. At the street doctors’ office, patients with mental problems are most often documented, followed by patients with heart diseases and endocrine problems. Serious health problems that require extra care are frequently registered, such as drug and alcohol addiction, HIV, tuberculosis and hepatitis C. Patients with mental problems and trauma have a larger share at the street doctor’s office than in a regular GP practice. The proportion of women has increased since 2006 as has the proportion of elderly patients. The proportion of patients with documented needs for cardiovascular diseases (in particular hypertension), endocrine disorders (in particular diabetes and thyroid diseases) and cancer has increased. It was concluded that a relatively large part of the patient contacts at the street doctor’s office is devoted to mental problems and trauma. As the proportion of patients with chronic diseases and risk factors is rising, street doctor care seems to move towards regular care. But extra care for serious classical health problems among homeless people is still necessary. Chapter 4 describes a register-based 10-year follow-up study of homeless in Rotterdam. After 2005, policy actions being implemented inRotterdam, theNetherlands, have improved the living conditions of this group. This study examines the effect of policies aimed at improving living conditions on mortality risks of homeless people. The participants are homeless adults (aged 18+ years) who visited one or more services for homeless people in Rotterdam in 2001. The intervention of local policies after 2005 was to get homeless people into housing, increase their participation in employment and other regular daytime activities, and controlling drug and alcohol addictions. The main outcome measure is mortality rate ratios calculated using Poisson regression. Differences in mortality between the periods 2001–05 vs. 2006–10 were assessed.