基于价值共创理论的基层2型糖尿病远程数字化管理实施机制——基层医务人员质性研究

Implementation Mechanism for Remote Digital Management of Type 2 Diabetes at the Primary Care Level Based on the Theory of Value Co-Creation—A Qualitative Study of Primary Care Healthcare Providers

摘要: 目的：基于服务主导逻辑下的价值共创理论，从基层医务人员视角探索基层2型糖尿病远程数字化管理的价值共创形成机制，为优化基层慢病数字化服务提供参考依据。方法：采用描述性质性研究，2025年11~12月采用目的抽样法，纳入上海市浦东新区参与远程血糖管理项目的全科医生、社区护士、家庭医生签约服务助手共15名。采用半结构化访谈收集资料，遵循COREQ规范实施资料收集与主题框架分析法，依托价值共创理论构建初始编码框架，双人独立编码完成资料分析。结果：共提炼3个一级主题、9个二级主题：① 价值共创形成基础：数字技术赋能、患者参与储备、长期签约医患信任；② 价值共创实施过程：数据共同解读、协同认知建立、个体化方案动态调整；③ 价值共创影响因素：团队协作、专业培训为促进因素，系统割裂、绩效激励不足、医护角色转型压力、老年患者数字鸿沟为阻碍因素。三者联动构成基层糖尿病数字化管理价值共创完整机制。结论：基层糖尿病远程数字化价值共创进行全程管理是融合数字技术、患者、医患关系共同作用的动态过程。基层数字化慢性病管理不能单一依赖技术升级，需同步优化人力配置、信息系统与组织激励机制，推动医患持续协同管理。

Abstract: Objective: Based on the theory of value co-creation within a service-dominant logic, this study explores the mechanisms underlying value co-creation in the remote digital management of type 2 diabetes at the primary care level from the perspective of primary care healthcare providers, providing a reference for optimizing digital services for chronic diseases in primary care. Methods: A descriptive qualitative study was conducted. From November to December 2025, purposeful sampling was used to recruit a total of 15 participants—including general practitioners, community nurses, and family doctor contract service assistants—from Pudong New Area, Shanghai, who were involved in a remote blood glucose management project. Data were collected through semi-structured interviews. Data collection and thematic framework analysis were conducted in accordance with the COREQ guidelines. An initial coding framework was constructed based on the theory of value co-creation, and data analysis was completed through independent coding by two researchers. Results: A total of 3 first-level themes and 9 second-level themes were identified: (1) Foundations for value co-creation: digital technology empowerment, patient engagement capacity, and long-term trust between contracted physicians and patients; (2) Implementation process of value co-creation: joint data interpretation, establishment of shared cognition, and dynamic adjustment of individualized treatment plans; (3) Factors influencing value co-creation: team collaboration and professional training as facilitating factors; system fragmentation, insufficient performance incentives, pressure from the transformation of healthcare professional roles, and the digital divide among elderly patients as hindering factors. The interaction of these three elements constitutes a comprehensive mechanism for value co-creation in the digital management of diabetes at the primary care level. Conclusion: The process of value co-creation in remote digital diabetes management at the primary care level is a dynamic process that integrates the combined effects of digital technology, patients, and the doctor-patient relationship. Digital chronic disease management at the primary care level cannot rely solely on technological upgrades; it requires the simultaneous optimization of human resource allocation, information systems, and organizational incentive mechanisms to promote continuous collaborative management between doctors and patients.