Abstract: Background There is a significant adherence gap in the application of diabetes complication management guidelines in primary care practice. Objective To explore the internal and external factors influencing the adherence gap of diabetes complication management guidelines from the perspective of community general practitioners, and to provide evidence for optimizing guideline application in primary care practice. Methods A qualitative descriptive research design was employed. From March 2025 to January 2026, semi-structured in-depth interviews were conducted with 36 general practitioners from 15 community health service centers in Shanghai. Thematic analysis with a hybrid approach was used to analyze the interview data. Results A total of 9 sub-themes under 3 themes were generated. Structural constraints of the implementation environment in primary care institutions included limited examination equipment and therapeutic drugs, insufficient consultation time, patients' cognitive limitations and lack of trust, and the invisibility of preventive clinical work coupled with a lack of financial incentives. Clinical implementation limitations of general practitioners included the deterioration of clinical skills, cognitive complexity and ambivalence, and the contraction of clinical scope with defensive responsibility transfer. Pathways to bridge the adherence gap included the demand for implementation tools and the enhancement of skills in doctor-patient communication and health education. Conclusion The guideline adherence gap results from the dual interaction between objective systemic constraints and subjective behavioral deviations among general practitioners. Bridging the gap requires coordinated efforts in three dimensions: optimizing resource allocation and incentive mechanisms, promoting the transformation of guidelines into practical tools, and strengthening the skills and professional identity of general practitioners, thereby improving the quality of the clinical process in diabetes complication management.

Key words: Diabetes complications, General practitioners, Adherence gap, Root cause analysis, Community health services, Motivational interviewing, Clinical quality

摘要： 背景 糖尿病并发症管理指南在基层实施中存在明显依从性差距。目的 探讨社区全科医生视角下糖尿病并发症管理指南依从性差距的内外部影响因素，为优化基层医疗实践中的指南应用提供依据。方法 采用定性描述研究方法，于 2025 年 3 月—2026 年 1 月对上海市 15 家社区卫生服务中心的 36 名全科医生进行半结构式深度访谈；运用主题分析法对访谈资料进行混合路径分析。结果 本次访谈共生成了 3 个主题下的 9 个亚主题。基层医疗卫生机构实施环境的结构制约，包括检查设备与治疗药物有限、门诊时长不足、患者认知局限与信任缺位、预防性临床劳动的隐性化与经济激励缺失；全科医生的临床实施局限，包括临床技能退化、认知复杂性和矛盾、临床边界缩小与防御性责任转移；以及弥合实施差距的路径，包括对实施工具的需求，以及对医患沟通与健康教育技能的补强。结论 指南依从性差距是客观系统结构制约与全科医生主观行为偏差双重作用的结果。弥合差距需从优化资源配置与激励机制、推动指南向实战化工具转型、强化全科医生技能与职业认同三个方面协同发力，提升全科医生在糖尿病并发症管理上的临床过程质量。

关键词: 糖尿病并发症, 全科医生, 依从性差距, 影响因素分析, 社区卫生服务, 动机性访谈, 临床质量