{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:51:13Z","timestamp":1754488273427,"version":"3.30.1"},"reference-count":27,"publisher":"CAIRN","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,7]]},"abstract":"<jats:p>Introduction\u00a0: La polypathologie est une probl\u00e9matique de sant\u00e9 qui concerne de plus en plus de personnes vivant avec le VIH (PVVIH) et dont la fr\u00e9quence augmente avec l\u2019\u00e2ge. Le recul actuel de l\u2019hospitalo-centrisme devrait amener le m\u00e9decin g\u00e9n\u00e9raliste \u00e0 occuper une place centrale dans le suivi extra-hospitalier des PVVIH \u00e2g\u00e9es et polypathologiques. Notre \u00e9tude cherche \u00e0 comprendre la place qu\u2019occupent r\u00e9ellement les m\u00e9decins g\u00e9n\u00e9ralistes et les barri\u00e8res qu\u2019ils rencontrent dans la prise en charge des PVVIH \u00e2g\u00e9es et polypathologiques. M\u00e9thodes\u00a0: Nous pr\u00e9sentons ici les r\u00e9sultats d\u2019une \u00e9tude ancillaire d\u2019une pr\u00e9c\u00e9dente recherche (ANRS EP66-SEPTAVIH) qui \u00e9value la fragilit\u00e9 chez les PVVIH \u00e2g\u00e9es de 70 ans et plus. Elle repose sur des entretiens approfondis r\u00e9alis\u00e9s aupr\u00e8s de m\u00e9decins g\u00e9n\u00e9ralistes et de PVVIH \u00e2g\u00e9es de 70 ans et plus. Les donn\u00e9es ont fait l\u2019objet d\u2019un traitement manuel et les th\u00e8mes et sous-th\u00e8mes identifi\u00e9s ont \u00e9t\u00e9 class\u00e9s dans un tableau sous forme de grilles d\u2019\u00eatre soumis \u00e0 une analyse th\u00e9matique transversale. R\u00e9sultats\u00a0: \u00c0 partir de 30 entretiens r\u00e9alis\u00e9s d\u2019avril 2020 \u00e0 juin 2021 aupr\u00e8s de 10 m\u00e9decins g\u00e9n\u00e9ralistes et 20 PVVIH \u00e2g\u00e9es de 70 ans et plus et polypathologiques, cette \u00e9tude identifie les difficult\u00e9s que les m\u00e9decins g\u00e9n\u00e9ralistes rencontrent pour intervenir pleinement dans la prise en charge de ces patients. Leur suivi est caract\u00e9ris\u00e9 par des cloisonnements symboliques entre groupes de professionnels\u00a0: morcellement organisationnel entre m\u00e9decins g\u00e9n\u00e9ralistes et sp\u00e9cialistes, peur d\u2019empi\u00e9ter sur le r\u00f4le de l\u2019autre professionnel de sant\u00e9 et absence fr\u00e9quente de formalisation des r\u00f4les dans la coordination des soins. Conclusions\u00a0: Afin de favoriser un suivi optimal et d\u2019am\u00e9liorer le v\u00e9cu des PVVIH \u00e2g\u00e9es, il est important que le r\u00f4le de chaque intervenant soit mieux d\u00e9fini pour un meilleur suivi partag\u00e9.<\/jats:p>","DOI":"10.3917\/spub.231.0037","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T07:32:31Z","timestamp":1686900751000},"page":"37-45","source":"Crossref","is-referenced-by-count":2,"title":["Polypathologie des personnes \u00e2g\u00e9es vivant avec le VIH\u00a0: quelle gestion en m\u00e9decine g\u00e9n\u00e9rale\u00a0?"],"prefix":"10.3917","volume":"Vol. 35","author":[{"given":"C\u00e9sarine","family":"Sambou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dolor\u00e8s","family":"Pourette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Debeaudrap","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariem","family":"Raho-Moussa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clotilde","family":"Allavena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2273","reference":[{"unstructured":"1 Nicholson K, Terry AL, Fortin M, Williamson T, Thind A. Understanding multimorbidity in primary health care. Can Fam Physician. 2015;61(10):918, e489-90. PMID: 26 472 799; PMCID: PMC4607340.","key":"rb1"},{"doi-asserted-by":"crossref","unstructured":"2 https:\/\/doi.org\/10.1370\/afm.1337 Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med. 2012;10(2):142-51. DOI: .","key":"rb2","DOI":"10.1370\/afm.1337"},{"unstructured":"4 e https:\/\/www.natap.org\/2012\/IAS\/currier.pdf Currier JS. Intersection of non-communicable diseases and aging in HIV [Communication]. XIX\u00a0AIDS Plenary, 22-27 July 2012, Washington (DC). [Visit\u00e9 le 21\/02\/2023]. En ligne\u00a0: .","key":"rb4"},{"doi-asserted-by":"crossref","unstructured":"5 https:\/\/doi.org\/10.1002\/jia2.25233 Castilho JL, Escuder MM, Veloso V, Gomes JO, Jayathilake K, Ribeiro S, et al. Trends and predictors of non-communicable disease multimorbidity among adults living with HIV and receiving antiretroviral therapy in Brazil. J Int AIDS Soc. 2019;22(1):e25233. DOI: .","key":"rb5","DOI":"10.1002\/jia2.25233"},{"unstructured":"6 https:\/\/doi.org\/10.1093\/cid\/cix998 Wong C, Gange SJ, Moore RD, Justice AC, Buchacz K, Abraham AG, et al. Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States. Clin Infect Dis. 2018;66(8):1230-8. DOI: .","key":"rb6"},{"doi-asserted-by":"crossref","unstructured":"7 https:\/\/doi.org\/10.1093\/cid\/cir626 Hasse B, Ledergerber B, Furrer H, Battegay M, Hirschel B, Cavassini M, et al. Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis. 2011;53(11):1130-9. DOI: .","key":"rb7","DOI":"10.1093\/cid\/cir626"},{"unstructured":"8 https:\/\/doi.org\/10.1093\/cid\/ciu701 Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis. 2014;59(12):1787-97. DOI: .","key":"rb8"},{"unstructured":"9 https:\/\/www.nat.org.uk\/blog\/providing-coordinated-care-people-living-hiv National Aids Trust (NAT). Providing coordinated care for people living with HIV [Internet]. 2020. [Visit\u00e9 le 21\/02\/2023]. En ligne\u00a0: .","key":"rb9"},{"doi-asserted-by":"crossref","unstructured":"10 https:\/\/www.revmed.ch\/revue-medicale-suisse\/2013\/revue-medicale-suisse-370\/quelle-organisation-des-soins-pour-le-patient-polymorbide Perrier A, Gaspoz JM, Waeber G, Cornuz J. Quelle organisation des soins pour le patient polymorbide\u00a0? Rev Med Suisse. 2013;9(370):174-81. [Visit\u00e9 le 21\/02\/2023]. 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En ligne\u00a0: .","key":"rb12"},{"doi-asserted-by":"crossref","unstructured":"13 https:\/\/doi.org\/10.1016\/j.jana.2017.04.003 Slomka J, Prince-Paul M, Webel A, Daly BJ. Multimorbidity with HIV: Views of community-based people living with HIV and other chronic conditions. J Assoc Nurses AIDS Care. 2017;28(4):603-11. DOI: .","key":"rb13","DOI":"10.1016\/j.jana.2017.04.003"},{"key":"rb14","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3917\/sss.313.0071","article-title":"Polyprescription m\u00e9dicamenteuse et polypathologies chroniques\u00a0: ce qu'en disent les m\u00e9decins g\u00e9n\u00e9ralistes","volume":"31","author":"Clerc Pascal","year":"2013","journal-title":"Sciences sociales et sant\u00e9","ISSN":"https:\/\/id.crossref.org\/issn\/0294-0337","issn-type":"print"},{"doi-asserted-by":"crossref","unstructured":"15 https:\/\/doi.org\/10.15256\/joc.2014.4.31 Duguay C, Gallagher F, Fortin M. The experience of adults with multimorbidity: A qualitative study. J Comorb. 2014;4(1):11-21. DOI: .","key":"rb15","DOI":"10.15256\/joc.2014.4.31"},{"key":"rb16","doi-asserted-by":"publisher","first-page":"M146-M157","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried L. P.","year":"2001","journal-title":"The Journals of Gerontology Series A: Biological Sciences and Medical Sciences","ISSN":"https:\/\/id.crossref.org\/issn\/1079-5006","issn-type":"print"},{"key":"rb17","doi-asserted-by":"publisher","first-page":"2880-2888","DOI":"10.1093\/cid\/ciz1171","article-title":"Multimorbidity in Elderly Persons According to the Year of Diagnosis of Human Immunodeficiency Virus Infection: A Cross-sectional Dat\u2019AIDS Cohort Study","volume":"71","author":"Demont\u00e8s Marie","year":"2020","journal-title":"Clinical Infectious Diseases","ISSN":"https:\/\/id.crossref.org\/issn\/1058-4838","issn-type":"print"},{"unstructured":"18 Labb\u00e9 F. HIV, stigma and shame in Fiji [Th\u00e8se]. Rennes\u00a0: EHESS\u00a0; 2020.","key":"rb18"},{"key":"rb19","doi-asserted-by":"publisher","first-page":"375-384","DOI":"10.3917\/spub.139.0375","article-title":"La stigmatisation des PVVIH en Afrique\u00a0: analyse de ses formes et manifestations au Burkina Faso","volume":"Vol. 26","author":"Ky-Zerbo Odette","year":"2014","journal-title":"Sant\u00e9 Publique","ISSN":"https:\/\/id.crossref.org\/issn\/0995-3914","issn-type":"print"},{"unstructured":"20 https:\/\/www.irdes.fr\/Publications\/2010\/Qes156.pdf Clerc P, Le Breton J, Mousqu\u00e8s J, Hebbrecht G, de Pouvourille G. Les enjeux du traitement m\u00e9dicamenteux des patients atteints de polypathologies\u00a0: R\u00e9sultats de l\u2019\u00e9tude exp\u00e9rimentale Polychrome. QES. 2010;(156):1-6. [Visit\u00e9 le 21\/02\/2023]. En ligne\u00a0: .","key":"rb20"},{"unstructured":"21 https:\/\/www.irdes.fr\/recherche\/questions-d-economie-de-la-sante\/204-la-polymedication-definitions-mesures-et-enjeux.pdf Monegat M, Sermet C. La polym\u00e9dication\u00a0: d\u00e9finitions, mesures et enjeux. Revue de la litt\u00e9rature et tests de mesure. QES. 2014;(204):1-8. [Visit\u00e9 le 21\/02\/2023]. En ligne\u00a0: .","key":"rb21"},{"unstructured":"22 https:\/\/www.oecd-ilibrary.org\/social-issues-migration-health\/health-reform\/reconfiguring-health-professions-in-times-of-multimorbidity_9789264122314-7-en Plochg T, Klazinga N, Sch\u00f6nstein M, Starfield B. Reconfiguring health professions in times of multimorbidity eight recommendations for change. In: OECD. Health Reform: Meeting the challenge of ageing and multiple morbidities. OECD 50th Anniversary Conference. Paris\u00a0: OECD Publishing; 2011. p. 109-141. [Visit\u00e9 le 21\/02\/2023]. En ligne\u00a0: .","key":"rb22"},{"doi-asserted-by":"crossref","unstructured":"23 https:\/\/doi.org\/10.1016\/S0140-6736(12)60240-2 Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. DOI: .","key":"rb23","DOI":"10.1016\/S0140-6736(12)60240-2"},{"key":"rb24","doi-asserted-by":"publisher","first-page":"15-28","DOI":"10.15256\/joc.2015.5.39","article-title":"Care Coordination of Multimorbidity: A Scoping Study","volume":"5","author":"Doessing Anne","year":"2015","journal-title":"Journal of Comorbidity","ISSN":"https:\/\/id.crossref.org\/issn\/2235-042X","issn-type":"print"},{"key":"rb25","isbn-type":"print","doi-asserted-by":"publisher","first-page":"205-220","DOI":"10.3917\/ehesp.bloy.2010.01.0205","volume-title":"La m\u00e9decine g\u00e9n\u00e9rale, une \u00ab\u00a0profession consultante\u00a0\u00bb entre profession savante et prestations de services","author":"Pennec Simone","year":"2010","ISBN":"https:\/\/id.crossref.org\/isbn\/9782810900213","journal-title":"Singuliers g\u00e9n\u00e9ralistes"},{"unstructured":"26 McDonald KM, Sundaram V, Bravata DM, Lewis R, Lin N, Kraft SA, et al. AHRQ Technical Reviews. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (vol. 7: Care Coordination). Rockville (MD): Agency for Healthcare Research and Quality; 2007.","key":"rb26"},{"doi-asserted-by":"crossref","unstructured":"27 https:\/\/doi.org\/10.3917\/ehesp.bloy.2010.01.0253 Sarradon-Eck A. \u00ab\u00a0Qui mieux que nous\u00a0?\u00a0\u00bb Les ambivalences du \u00ab\u00a0g\u00e9n\u00e9raliste-pivot\u00a0\u00bb du syst\u00e8me de soins. Singuliers g\u00e9n\u00e9ralistes. Rennes\u00a0: Presses de l\u2019EHESP\u00a0; 2010. p. 253-70. DOI: .","key":"rb27","DOI":"10.3917\/ehesp.bloy.2010.01.0253"},{"doi-asserted-by":"crossref","unstructured":"28 https:\/\/doi.org\/10.1186\/1758-2652-13-47 Smith JH, Whiteside A. The history of AIDS exceptionalism. J Int AIDS Soc. 2010;13(1):47. 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