Abstract: Background　Opinions on the Implementation of Appointment Services in Public Hospitals〔WYGF（2009）No.95〕 issued by the original Ministry of Health put forward that public hospitals should be scheduled for appointments，and primary health care institutions are also within the scope of implementation.So analyzing the implementation of appointment services is of great significance for optimizing the diagnosis and treatment model of primary health care institutions.Objective　To explore the implementation status of appointment services in community health centers（CHCs） in downtown Shanghai，providing suggestions for optimizing the primary healthcare system.Methods　The survey was conducted across all the 10 CHCs located in Huangpu District，Shanghai through August 27th to September 11th，2018，with the method of focus group discussion.Participants were directors，and representatives of information department workers，and first-line clinicians and nurses recruited from the CHCs（4-6 cases from each）．Information about current implementation of appointment services，including implementation plans，practice and evaluation were collected.Description was formed after coding，classification and condensing with content analysis.Results　A total of 44 medical professionals attended.The survey that appointment services had been carried out in 9 CHCs.There were 3 major types of making appointments：making an appointment without medical record（3 CHCs），making an appointment with medical record，and consulting on the appointment date（7 CHCs），making an appointment with medical record，and having priority in consulting during the appointment period（5 CHCs）．Multiple CHCs implement different appointment modes in different departments.But only a small percentage of patients made appointments，accounting for less than 10% of the total outpatient visits.The majority of patients who frequently used the appointment system were elderly adults，mainly for regular revisits or prescriptions.Those making an general-specialty appointment were mainly for obtaining specialty treatments.Patients preferred making an appointment during their visits，and the no-show rate was relatively low.Reducing the waiting time for consultation or improving the treatment environment，could alleviate patients' anxiety during consultation.However，all the types of making an appointment helped little in terms of balancing the number of patients in peak hours and off-peak hours.Neither would doctors lengthen the time of treatment for patients with an appointment.Conclusion　The three types of making an appointment used in the CHCs，making an appointment without medical record，making an appointment with medical record，and having the priority in consulting during the appointment period if making an appointment with medical record，shows that the precise treatment time distribution and binding force for both patients and healthcare providers shave been gradually enhanced.Also，from the perspective of further upgrading the allocation of medical resources，the implementation of precise specialty appointment services is more mature than that of general appointment services.Overall，delivering appointment services for featured outpatient care that is different from general services，for example，home-based health management，would be the development direction of the general appointment services in the community.

Key words: Community health services, Community health centers, Appointments and schedules, Waiting time, Qualitative research, Shanghai

摘要： 背景　《卫生部关于在公立医院施行预约诊疗服务工作的意见》（卫医管发﹝2009﹞95号）提出公立医院应实施预约就诊，基层医疗卫生机构也在实施范围内。调查基层医疗卫生机构预约就诊的开展现况，对于优化其诊疗模式具有重要意义。目的　了解上海市中心城区社区卫生服务中心预约就诊服务开展现况，为优化基层诊疗模式提供政策建议。方法　于2018-08-27至2018-09-11，对上海市黄浦区的所有社区卫生服务中心（共10家）进行调研。采用专题小组访谈的方式，逐家单位进行社区预约就诊实施方案、实施现况及实施效果评价的信息采集，受访者为各社区卫生服务中心的业务分管主任及医务科、信息科、一线医护人员代表4~6名。采用内容分析法，对访谈资料进行编码、归类、精简，形成描述性语言。结果　共44名医务人员接受了访谈。10家社区卫生服务中心中，9家开展了预约就诊服务。预约就诊模式可分为无记录预约（3家）、有记录预约且按约定日期就诊（7家）、有记录预约且在约定时间段可优先就诊（5家）3种，多家社区卫生服务中心在不同科室实施不同的预约就诊模式。社区预约就诊门诊量较少，占总门诊量的比重不超过10%；预约就诊患者以老年人为主，就诊目的主要为复诊和配药，预约全专联合门诊的主要就诊目的为获得专科诊疗服务；预约方式主要为现场预约；预约就诊的爽约率总体较低。减少候诊时长或改善就诊环境的预约就诊，可以缓解患者的就诊焦虑；但各类预约就诊模式在平衡医生接诊的高峰期和低谷期方面无明显效果，医生对预约就诊患者的接诊时间也未延长。结论　社区卫生服务中心目前在开展的3类预约就诊模式，从无记录到有记录且具体到时间段优先就诊，体现了预约就诊对医患双方诊疗时间分配的精确度和约束力度的加强；且从促进医疗卫生资源合理分配方面来看，社区卫生服务中心开展小专科预约就诊，相比于全科预约就诊发展更为成熟；有别于普通全科门诊的、提供家庭健康管理等服务的特色预约门诊，可能为社区全科预约就诊服务的发展方向。

关键词: 社区卫生服务, 社区卫生中心, 病人预约和时间安排, 候诊时长, 定性研究, 上海