Institute of General Practice, Faculty of Medicine, Christian-Albrechts-Universität zu Kiel; Universitätsklinikum Hamburg-Eppendorf (UKE), Department of Primary Medical Care.
Dtsch Arztebl Int. 2017 Oct 6;114(40):673-679. doi: 10.3238/arztebl.2017.0673.
The homeless are often in poor health, and their risk of premature death is three to four times that of the general population. This article is intended to provide an overview of the medical care of the homeless in Germany.
We selectively reviewed pertinent scientific and non-scientific publications from the years 2000-2017 that were retrieved from PubMed, from the reports of the German Homeless Aid Society (Bundesarbeitsgemeinschaft Wohnungslosenhilfe), from the websites of homeless aid organizations, and from Google Scholar.
At least 75% of the homeless currently suffer from a mental illness requiring treatment. Common somatic problems include respiratory (6-14%) and cardiovascular disorders (7-20%), injuries and intoxications (5-15%), and infectious and parasitic diseases (10-16%). To circumvent the multiple barriers impeding homeless people's access to standard medical care (lack of health insurance, a feeling of being unwelcome, lack of disease awareness, impaired capacity for compliance), medical help is offered to them outside the system in a number of ways, embedded in an overall scheme of social and practical assistance with daily living. These medical resources differ from region to region. They are often underfinanced and tend to focus on acute general medical care, with limited access to specialists.
More heath care resources need to be made available to the homeless beyond standard medical care. Concrete suggestions are discussed in the text.
无家可归者的健康状况往往较差，其早逝风险是一般人群的三到四倍。本文旨在概述德国无家可归者的医疗服务。
我们有选择性地查阅了 2000 年至 2017 年间从 PubMed、德国无家可归援助协会（Bundesarbeitsgemeinschaft Wohnungslosenhilfe）的报告、无家可归援助组织的网站以及 Google Scholar 检索到的相关科学和非科学出版物。
目前至少有 75%的无家可归者患有需要治疗的精神疾病。常见的躯体问题包括呼吸道疾病（6-14%）和心血管疾病（7-20%）、损伤和中毒（5-15%）以及传染病和寄生虫病（10-16%）。为了克服妨碍无家可归者获得标准医疗服务的多重障碍（缺乏健康保险、不受欢迎的感觉、缺乏疾病意识、遵医嘱能力受损），通过多种方式在系统之外向他们提供医疗帮助，嵌入到社会和实际日常生活援助的整体计划中。这些医疗资源因地区而异。它们往往资金不足，往往侧重于急性一般医疗保健，获得专家的机会有限。
需要向无家可归者提供超出标准医疗服务的更多医疗保健资源。文中讨论了具体建议。
