A $\mathbb Z$-linear map $f:\mathbb R\rightarrow\mathbb R$ must also be $\mathbb Q$-linear map due to the argument you provide. Specifically, $\mathbb Z$-linearity gives
$$b\cdot f\left(\frac{a}b\cdot x\right) = f(a\cdot x) = a\cdot f(x)$$
which can be solved as
$$f\left(\frac{a}b\cdot x\right) = \frac{a}b\cdot f(x).$$
This is a big improvement since vector spaces tend to be better behaved than modules - and we've reduced our question to asking about linear maps $\mathbb R\rightarrow\mathbb R$ as vector spaces over $\mathbb Q$.
These maps can be described using the axiom of choice - which is equivalent to the following statement:
Every vector space $V$ has a basis $B$.
As a particular case of this, $\mathbb R$ must have some basis $B$ as a vector space over $\mathbb Q$ - meaning that every element of $\mathbb R$ is a finite sum of elements of $B$ with weights from $\mathbb Q$. Note that such a basis has the same cardinality as $\mathbb R$ and depends on the axiom of choice to construct.
Then we can use typical vector space facts to finish - in particular, that defining a map from a vector space can be done just by choosing its values on each basis element. Formally:
If $V$ and $W$ are vector spaces and $B$ is a basis for $V$, then for any function $g:B\rightarrow W$, there is a unique linear map $f:V\rightarrow W$ such that $f(b)=g(b)$ whenever $b\in B$.
We then apply that to the spaces in question: the set of $\mathbb Q$-linear maps $\mathbb R\rightarrow\mathbb R$ is in bijection with the set of functions $B\rightarrow\mathbb R$ where $B$ is a $\mathbb Q$-basis of $\mathbb R$. To say the least, this is a very big set and not at all as nice a result as one has with $\mathbb Q\rightarrow \mathbb Q$.
Here's a nicer, less axiom-of-choice flavor of the same intuition: consider $\mathbb Q$-linear maps $\mathbb Q[\sqrt{2}]\rightarrow \mathbb Q[\sqrt{2}]$ - where $\mathbb Q[\sqrt{2}]$ is the set of expressions of the form $a+b\sqrt{2}$ for rational $a$ and $b$. You could explicitly note $\{1,\sqrt{2}\}$ as a $\mathbb Q$-basis and note that such linear maps are just pairs of values from $\mathbb Q[\sqrt{2}]$ - one specifying the image of $1$ and the other specifying the image of $\sqrt{2}$.
The axiom of choice lets us claim that $\mathbb R$ is somehow like that, except that instead of adding one new element ($\sqrt{2}$) we add uncountably many new elements instead!
It's probably worth noting that this whole discussion with $\mathbb R$ relies crucially on the axiom of choice - without the axiom of choice, it is not only consistent that there might not be a $\mathbb Q$-basis $B$ for $\mathbb R$, but it's even consistent that every $\mathbb Q$-linear map $\mathbb R\rightarrow \mathbb R$ could also be $\mathbb R$-linear - so without the axiom of choice, it's hard to say much interesting about the set you're asking about.