If you're looking for a particularly Microsoft-centric solution, you can connect to the Access database through ADO with Win32::OLE. Here's a snippet from some of my own code that was done using this technique, to give you a feel for what coding in this manner is like:

use Win32::OLE;
use Win32::ADO;        # just a set of constants for ADO

my $conn = Win32::OLE->new('ADODB.Connection');
$conn->Open('database');
my $rs = Win32::OLE->new('ADODB.Recordset');
$rs->Open("table", $conn, adOpenDynamic, adCmdTable);

for my $item (@items) {
    $rs->Movefirst;
    $rs->Find("ItemID = ".$$item{'ItemID'});
    if ($rs->{EOF}) {
        $rs->AddNew(["ItemID", "EndDate", "Relisted", "RelistClass", "
+RelistKey"], 
                    [$$item{'ItemID'}, $item_endtime, 0, $$item{'Relis
+tClass'}, $$item{'Key'}]);
    } else {
        $rs->Fields('Relisted')->{Value} = 0;
        $rs->Update
    }
}
[download]

You may find that ADO is actually quite a solid and well-designed database access API. The specification for it can be found in MSDN.